title: Development of key performance indicators for emergency departments in Ireland using an electronic modified-Delphi consensus approach.
abstract: OBJECTIVE
  The objective of this study was to develop a consensus among emergency medicine (EM) specialists working in Ireland for emergency department (ED) key performance indicators (KPIs).
  
  
  METHODS
  The method employed was a three-round electronic modified-Delphi process. An online questionnaire with 54 potential KPIs was set up for round 1 of the Delphi process. The Delphi panel consisted of all registered EM specialists in Ireland. Each indicator on the questionnaire was rated using a five-point Likert-type rating scale. Agreement was defined as at least 70% of the responders rating an indicator as 'agree' or 'strongly agree' on the rating scale. Data were analysed using standard descriptive statistics. Data were also analysed as the mean of the Likert rating with 95% confidence intervals (95% CIs). Sensitivity of the ratings was examined for robustness by bootstrapping the original sample. Statistical analyses were carried out using SPSS version 16.0.
  
  
  RESULTS
  The response rates in rounds 1, 2 and 3 were 86, 88 and 88%, respectively. Ninety-seven potential indicators reached agreement after the three rounds. In the context of the Donabedian structure-process-outcome framework of performance indicators, 41 (42%) of the agreed indicators were structure indicators, 52 (54%) were process indicators and four (4%) were outcome indicators. Overall, the top-three highest rated indicators were: presence of a dedicated ED clinical information system (4.7; 95% CI 4.6-4.9), ED compliance with minimum design standards (4.7; 95% CI 4.5-4.8) and time from ED arrival to first ECG in suspected cardiac chest pain (4.7; 95% CI 4.5-4.9). The top-three highest rated indicators specific to clinical care of children in EDs were: time to administration of antibiotics in children with suspected bacterial meningitis (4.6; 95% CI 4.5-4.8), separate area available within EDs (seeing both adults and children) to assess children (4.4; 95% CI 4.2-4.6) and time to administration of analgesia in children with forearm fractures (4.4; 95% CI 4.2-4.7).
  
  
  CONCLUSIONS
  Employing a Delphi consensus process, it was possible to reach a consensus among EM specialists in Ireland on a suite of 97 KPIs for EDs.
authors.affiliation: Emergency Care Research Unit, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland. awakai@rcsi.ie
authors.forename: Abel
authors.initials: A
authors.lastname: Wakai
authors.forename: Ronan
authors.initials: R
authors.lastname: O'Sullivan
authors.forename: Paul
authors.initials: P
authors.lastname: Staunton
authors.forename: Cathal
authors.initials: C
authors.lastname: Walsh
authors.forename: Fergal
authors.initials: F
authors.lastname: Hickey
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Plunkett
mesh_terms: D000328:Adult; D032921:Consensus; D003697:Delphi Technique; D004635:Emergency Medicine / Q000592:standards* / Q000639:trends; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007494:Ireland; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires