Kwaliteit op de SEH-afdeling: een analyse van de bestaande pediatrische richtlijnen

Alessandrini E, Varadarajan K, Alpern ER, Gorelick MH, Shaw K, Ruddy RM, et al. Emergency department quality: an analysis of existing pediatric measures. Acad Emerg Med 2011 May;18(5):519-526.

DOELSTELLINGEN: Het Institute of Medicine (IOM) heeft de ontwikkeling van nationale richtlijnen aanbevolen voor het meten van prestaties bij de pediatrische spoedeisende zorg. De auteurs hebben deze studie uitgevoerd met als doel het opsommen en classificeren van de bestaande prestatie-indicatoren die relevant zijn voor de pediatrische spoedeisende zorg.

CONCLUSIES: Er is een breed scala aan relevante prestatie-indicatoren aanwezig bij de pediatrische spoedeisende zorg. Echter, de richtlijnen missen een systematische en uitvoerige benadering om de geleverde kwaliteit te kunnen evalueren.

OBJECTIVES: The Institute of Medicine (IOM) has recommended the development of national standards for the measurement of emergency care performance. The authors undertook this study with the goals of enumerating and categorizing existing performance measures relevant to pediatric emergency care.

METHODS: Potential performance measures were identified through a survey of 1) the peer-reviewed literature, 2) websites of organizations and societies pertaining to quality improvement, and 3) emergency department (ED) directors. Performance measures were enumerated and categorized, using consensus methods, on three dimensions: 1) the IOM quality domains; 2) Donabedian's structure/process/outcome framework; and 3) general, cross-cutting, or disease-specific measures.

RESULTS: A total of 405 performance measures were found for potential use for pediatric emergency care. When categorized by IOM domain, nearly half of the measures were related to effectiveness, while only 6% of measures addressed patient-centeredness. In the Donabedian dimension, 67% of measures were categorized as process measures, with 29% outcome and 4% structure measures. Finally, 31% of measures were general measures relevant to every ED visit. Although 225 measures (55%) were disease-specific, the majority (56%) of these measures related to only five common conditions.

CONCLUSIONS: A wide range of performance measures relevant to pediatric emergency care are available. However, measures lack a systematic and comprehensive approach to evaluate the quality of care provided

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