title: Selection of quality indicators for hospital-based emergency care in Denmark, informed by a modified-Delphi process.
abstract: BACKGROUND
  In 2013, Danish policy-makers on a nationwide level decided to set up a national quality of care database for hospital-based emergency care in Denmark including the selection of quality indicators. The aim of the study was to describe the Delphi process that contributed to the selection of quality indicators for a new national database of hospital-based emergency care in Denmark.
  
  
  METHODS
  The process comprised a literature review followed by a modified-Delphi survey process, involving a panel of 54 experts (senior clinicians, researchers and administrators from the emergency area and collaborating specialties). Based on the literature review, we identified 43 potential indicators, of which eight were time-critical conditions. We then consulted the Expert panel in two consecutive rounds. The Expert panel was asked to what extent each indicator would be a good measure of hospital-based emergency care in Denmark. In each round, the Expert panel participants scored each indicator on a Likert scale ranging from one (=disagree completely) through to six (=agree completely). Consensus for a quality indicator was reached if the median was greater than or equal to five (=agree). The Delphi process was followed by final selection by the steering group for the new database.
  
  
  RESULTS
  Following round two of the Expert panel, consensus was reached on 32 quality indicators, including three time-critical conditions. Subsequently, the database steering group chose a set of nine quality indicators for the initial version of the national database for hospital-based emergency care.
  
  
  CONCLUSIONS
  The two-round modified Delphi process contributed to the selection of an initial set of nine quality indicators for a new a national database for hospital-based emergency care in Denmark. Final selection was made by the database steering group informed by the Delphi process.
authors: Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. moesmann@gmail.com.
authors: Michael Moesmann
authors: MM
authors: Madsen
authors: Research Center for Emergency Medicine, University of Aarhus, Aarhus, Denmark. ahe@clin.au.dk.
authors: Andreas Halgreen
authors: AH
authors: Eiset
authors: Research Center for Emergency Medicine, University of Aarhus, Aarhus, Denmark. thejuliemac@gmail.com.
authors: Julie
authors: J
authors: Mackenhauer
authors: The Danish Clinical Registers, Aarhus, Denmark. anneodby@rm.dk.
authors: Annette
authors: A
authors: Odby
authors: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. cfc@clin.au.dk.
authors: Christian Fynbo
authors: CF
authors: Christiansen
authors: Department of Clinical Research and Education, Karolinska Institutet, Stockholm, Sweden. lisa.kurland@ki.se.|Department of EM, Södersjukhuset, Stockholm, Sweden. lisa.kurland@ki.se.
authors: Lisa
authors: L
authors: Kurland
authors: Research Center for Emergency Medicine, University of Aarhus, Aarhus, Denmark. hanskirk@rm.dk.
authors: Hans
authors: H
authors: Kirkegaard
mesh_terms: D032921:Consensus; D003697:Delphi Technique; D003718:Denmark; D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires