Methodology for Developing Quality Indicators for the Care of Older People in the Emergency Department

Melinda Martin-Khan; Ellen Burkett; Linda Schnitker; Richard N Jones; Leonard C Gray


BMC Emerg Med. 2013;13(23) 

In This Article


Quality indicators (QI) are quantitative measures that may be utilised to enable levels of performance to be determined and, as part of a quality management system, provide opportunity for benchmarking and improved care delivery.[29] They may also support accreditation, regulation, and patient and healthcare purchaser choice. This study will result in a suite of QIs for use in the ED care of elderly that will be:

  1. Valid

  2. Derived utilizing clinical data items from multiple sources, including a site audit, patient interview, administrative databases, the interRAI ED assessment tool and the medical record

  3. Feasible in terms of both cost & measurement

  4. Assess the full spectrum of Donabedian's domains including structure, process and outcomes[64]

  5. Designed utilizing data items and processes that are not unique to any one particular developed nation.

The predicted burgeoning in the number of older persons presenting to EDs combined with the recognised quality deficiencies in ED care delivery to this population, highlight the need for a quality framework for the care of older persons in ED. Additionally, high quality of care is associated with improved survival & health outcomes of elderly patients.[28] The development of well-selected, validated and economical QIs will allow appropriate targeting of resources (financial, education or quality management) to improve quality in areas with maximum potential for improvement. Conversely, the "blind" application of QIs not designed for nor tested in the ED setting, particularly in the absence of appropriate risk adjustment, may result in inappropriate misdirection of funding.