title: The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study.
abstract: BACKGROUND
  Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec.
  
  
  METHODS
  We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada. A standardized protocol was sent to each emergency department to collect data on 27 validated quality-of-care indicators in 8 categories: duration of stay, patient safety, pain management, pediatrics, cardiology, respiratory care, stroke and sepsis/infection. Data were collected by local professional medical archivists between June and December 2013.
  
  
  RESULTS
  Fifteen (58%) of the 26 emergency departments invited to participate completed data collection. The ability to measure the 27 quality-of-care indicators with the use of databases varied across departments. Centres 2, 5, 6 and 13 used databases for at least 21 of the indicators (78%-92%), whereas centres 3, 8, 9, 11, 12 and 15 used databases for 5 (18%) or fewer of the indicators. On average, the centres were able to measure only 41% of the indicators using heterogeneous databases and manual extraction. The 15 centres collected data from 15 different databases or combinations of databases. The average data collection time for each quality-of-care indicator varied from 5 to 88.5 minutes. The median data collection time was 15 minutes or less for most indicators.
  
  
  CONCLUSIONS
  Quality-of-care indicators were not easily captured with the use of existing databases in rural emergency departments in Quebec. Further work is warranted to improve standardized measurement of these indicators in rural emergency departments in the province and to generalize the information gathered in this study to other health care environments.
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Layani
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Richard
authors.initials: R
authors.lastname: Fleet
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Renée
authors.initials: R
authors.lastname: Dallaire
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Fatoumata K
authors.initials: FK
authors.lastname: Tounkara
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Julien
authors.initials: J
authors.lastname: Poitras
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Patrick
authors.initials: P
authors.lastname: Archambault
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Chauny
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Ouimet
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Josée
authors.initials: J
authors.lastname: Gauthier
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dupuis
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Alain
authors.initials: A
authors.lastname: Tanguay
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Lévesque
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Simard-Racine
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Haggerty
authors.affiliation: Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
authors.forename: France
authors.initials: F
authors.lastname: Légaré