Emergency department quality and safety indicators in resource-limited settings: an environmental survey

From the International Journal of Emergency Medicine:


As global emergency care grows, practical and effective performance measures are needed to ensure high quality care. Our objective was to systematically catalog and classify metrics that have been used to measure the quality of emergency care in resource-limited settings.


We searched MEDLINE, Embase, CINAHL, and the gray literature using standardized terms. The references of included articles were also reviewed. Two researchers screened titles and abstracts for relevance; full text was then reviewed by three researchers. A structured data extraction tool was used to identify and classify metrics into one of six Institute of Medicine (IOM) quality domains (safe, timely, efficient, effective, equitable, patient-centered) and one of three of Donabedian’s structure/process/outcome categories. A fourth expert reviewer blinded to the initial classifications re-classified all indicators, with a weighted kappa of 0.89.


A total of 1705 articles were screened, 95 received full text review, and 34 met inclusion criteria. One hundred eighty unique metrics were identified, predominantly process (57 %) and structure measures (27 %); 16 % of metrics were related to outcomes. Most metrics evaluated the effectiveness (52 %) and timeliness (28 %) of care, with few addressing the patient centeredness (11 %), safety (4 %), resource-efficiency (3 %), or equitability (1 %) of care.


The published quality metrics in emergency care in resource-limited settings primarily focus on the effectiveness and timeliness of care. As global emergency care is built and strengthened, outcome-based measures and those focused on the safety, efficiency, and equitability of care need to be developed and studied to improve quality of care and resource utilization.

Cleveland Clinic clarifies its trauma protocol for transferring kids after questions over child’s death

From Cleveland:

The Cleveland Clinic says it has clarified protocol for transferring critically injured pediatric trauma patients after a city council meeting raised questions over whether the recent death of a child could have been avoided with a transfer to a closer higher-level trauma center.

The Clinic will now send all children who arrive at its main campus needing Level 1 care directly to University Hospitals Rainbow Babies & Children’s Hospital, a spokeswoman said. Before, the region’s trauma network would have decided where to transport these patients.

The trauma network, Northern Ohio Trauma System or NOTS, transferred the 3-year-old gunshot victim by helicopter from the Clinic’s main campus emergency room to MetroHealth’s Medical Center’s Level 2 pediatric trauma center, according to hospital officials. Rainbow, which is about five miles closer, is home to Greater Cleveland’s only Level 1 pediatric trauma center.

Cloquet feels squeeze of ER doctor shortage

From the News Tribune:

For the first time in memory, there were no doctors to see patients in the emergency room Oct. 16 at Community Memorial Hospital in Cloquet.

According to Marilyn Sorenson, registered nurse and senior vice president of hospital operations at CMH, there has been a shortage of doctors across the U.S., and Cloquet finally felt the effect for the first time.

The issue occurred from 7 a.m. to 7 p.m. on a Friday, and many patients could be seen on a walk-in basis at Raiter Clinic.

Usually the ER can call in a local doctor or request a doctor from a temp service, but there were none available that day.

“We couldn’t get solid coverage in time,” Sorenson said.