Table 1

Criteria for emergency care clinical quality indicators in Africa

Inclusion criteriaExplanation
Represents conditions which:
 Occur with significant frequency
 Are epidemiologically significantThe acute condition has high morbidity and mortality if appropriate care is not received in a timely manner.
 Fall within the scope of emergency careThe scope of emergency care includes all acute presentations within cadres of medical specialty across the life-cycle; it does not include longitudinal chronic care for ongoing morbid conditions.
Example: While emergency care plays an important role in acute services for psychotic behaviour or suicidal ideation, ongoing mental health provision is best served by longitudinal chronic care.
 Have improved outcomes with optimal emergency careSome acute presentations are more influenced than others by the emergency care provided.
Example: Sepsis mortality is significantly impacted by early appropriate resuscitation.36
Represents conditions whose outcomes:
 Depend on currently available diagnostic test or equipmentThe diagnostic study must be readily available in the majority of emergency units.
Example: CT scans are unavailable in the majority of emergency units in Africa and even when available at a tertiary referral level, are difficult to access due to cost, maintenance and expertise.
 Depend on currently available therapeuticsThe therapeutic must be commonly available on national formularies, often included on the WHO Essential Medications List.37
Example: Tissue plasminogen activator would not be readily available in most African settings for treatment of acute stroke.
 Are feasible to collectMost charting systems in LMICs are paper-based and documentation varies significantly.
 Are applicable to the current reality of emergency care delivery in AfricaWhile there is need for ongoing development of emergency care, the proposed quality indicators must address the current status of care delivery.
  • LMICs, low-income and middle-income countries.