title: Developing quality indicators for physician-staffed emergency medical services: a consensus process.
abstract: BACKGROUND
  There is increasing interest for quality measurement in health care services; pre-hospital emergency medical services (EMS) included. However, attempts of measuring the quality of physician-staffed EMS (P-EMS) are scarce. The aim of this study was to develop a set of quality indicators for international P-EMS to allow quality improvement initiatives.
  
  
  METHODS
  A four-step modified nominal group technique process (expert panel method) was used.
  
  
  RESULTS
  The expert panel reached consensus on 26 quality indicators for P-EMS. Fifteen quality indicators measure quality of P-EMS responses (response-specific quality indicators), whereas eleven quality indicators measure quality of P-EMS system structures (system-specific quality indicators).
  
  
  CONCLUSIONS
  When measuring quality, the six quality dimensions defined by The Institute of Medicine should be appraised. We argue that this multidimensional approach to quality measurement seems particularly reasonable for services with a highly heterogenic patient population and complex operational contexts, like P-EMS. The quality indicators in this study were developed to represent a broad and comprehensive approach to quality measurement of P-EMS.
  
  
  CONCLUSIONS
  The expert panel successfully developed a set of quality indicators for international P-EMS. The quality indicators should be prospectively tested for feasibility, validity and reliability in clinical datasets. The quality indicators should then allow for adjusted quality measurement across different P-EMS systems.
authors.affiliation: Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway. helge.haugland@norskluftambulanse.no.|Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway. helge.haugland@norskluftambulanse.no.|Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. helge.haugland@norskluftambulanse.no.
authors.forename: Helge
authors.identifier: http://orcid.org/0000-0002-5869-6675
authors.initials: H
authors.lastname: Haugland
authors.affiliation: Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.|Department of Health Studies, University of Stavanger, Stavanger, Norway.|Division of Emergencies and Critical Care. Department of Anaesthesia, Oslo University Hospital, Oslo, Norway.
authors.forename: Marius
authors.initials: M
authors.lastname: Rehn
authors.affiliation: Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Anaesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway.
authors.forename: Pål
authors.initials: P
authors.lastname: Klepstad
authors.affiliation: Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.|Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway.|Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Andreas
authors.initials: A
authors.lastname: Krüger
mesh_terms: D032921:Consensus; D003697:Delphi Technique; D004632:Emergency Medical Services / Q000592:standards*; D010561:Personnel Staffing and Scheduling; D010820:Physicians; D058996:Quality Improvement; D019984:Quality Indicators, Health Care
keywords: Modified nominal group technique; Physician-staffed emergency medical services; Quality indicators