title: Improvement of clinical quality indicators through reorganization of the acute care by establishing an emergency department-a register study based on data from national indicators.
abstract: BACKGROUND
  The Emergency Departments (EDs) reorganization process in Denmark began in 2007 and includes creating a single entrance for all emergency patients, establishing triage, having a specialist in the front and introducing the use of electronic overview boards and electronic patient files. The aim of this study was to investigate the quality of acute care in a re-organized ED based on national indicator project data in a pre and post reorganizational setting.
  
  
  METHODS
  Quasi experimental design was used to examine the effect of the health care quality in relation to the reorganization of an ED. Patients admitted at Nykøbing Falster Hospital in 2008 or 2012 were included in the study and data reports from the national databases (RKKP) regarding stroke, COPD, heart failure, bleeding and perforated ulcer or hip fracture were analysed. Holbæk Hospital works as a control hospital. Chi-square test was used for analysing significant differences from pre-and post intervention and Z-test to compare the experimental groups to the control group (HOL). P < 0.05 was considered statistically significant.
  
  
  RESULTS
  We assessed 4584 patient cases from RKKP. A significant positive change was seen in all of the additional eight indicators related to stroke at NFS (P < 0.001); however, COPD indicators were unchanged in both hospitals. In NFS two of eight heart failure indicators were significantly improved after the reorganization (p < 0.01). In patients admitted with a bleeding ulcer 2 of 5 indicators were significantly improved after the reorganization in NFS and HOL (p < 0.01). Both compared hospitals showed significant improvements in the two indicators concerning hip fracture (p < 0.001). Significant reductions in the 30 day-mortality in patients admitted with stroke were seen when the pre- and the post-intervention data were compared for both NFS and HOL (p = 0.024).
  
  
  CONCLUSIONS
  During the organisation of the new EDs, several of the indicators improved and the overall 30 days mortality decreased in the five diseases. The development of a common set of indicators for monitoring acute treatment at EDs in Denmark is recommended.
authors.affiliation: Faculty of Health Science, University of Southern Denmark, 5230, Odense M, Denmark. mariasoee@gmail.com.|Emergency Department, Hospital of Nykøbing Falster, 4800, Nykøbing Falster, Denmark. mariasoee@gmail.com.
authors.forename: Maria Søe
authors.initials: MS
authors.lastname: Mattsson
authors.affiliation: Emergency Department, Hospital of Nykøbing Falster, 4800, Nykøbing Falster, Denmark. nickm@dadlnet.dk.|Department of Cardiology, Bispebjerg Hospital, 2400, Copenhagen, NV, Denmark. nickm@dadlnet.dk.
authors.forename: Nick
authors.initials: N
authors.lastname: Mattsson
authors.affiliation: Emergency Department, Hospital of Nykøbing Falster, 4800, Nykøbing Falster, Denmark. hbjo@regionsjaelland.dk.
authors.forename: Hanne B
authors.initials: HB
authors.lastname: Jørsboe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000592:standards* / Q000639:trends; D016638:Critical Illness / Q000628:therapy*; D003718:Denmark; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000592:standards*; D012042:Registries; D012189:Retrospective Studies