Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 16;33(1):127.
doi: 10.1186/s13049-025-01442-y.

Outcome metrics in recommended performance measurement tools for emergency department performance evaluation: a systematic review

Tytti Kristiina Toukola  1 , Reija Katri Kyllikki Mertanen  2 , Johanna Marjut Kaartinen  3 , Eeva Anneli Tuunainen  4   5 , Maaret Kaarina Castrén  3 , Paulus Mikael Torkki  6   7
Affiliations

Outcome metrics in recommended performance measurement tools for emergency department performance evaluation: a systematic review

Tytti Kristiina Toukola et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: There is no established protocol for measuring the overall performance of an emergency department (ED). This study sought to evaluate in terms of outcome measures the existing measurement tools created for ED use.

Design: A comprehensive systematic literature review was conducted following the PRISMA guidelines. A systematic literature search was performed in databases of Medline and Scopus using the following eligibility criteria: (1) article context is the hospital ED; (2) the purpose is to develop or use a measurement tool concerning either quality or value; (3) the measurement tool evaluates the overall ED performance; (4) the measurement tool consists of more than two single performance indicators; and (5) the article is published in English.

Main results: Fifteen unique articles met the eligibility criteria and were included in the systematic review. The Delphi method was the most popular method for identifying the recommended performance indicators for ED use. Ten articles defined outcome metrics as a separate category of indicators. The indicators perceived as outcome metrics differed widely among the studies. The outcome metrics recommended can be divided into the following five dimensions: reattendances, mortality, diagnostic and procedural errors and complications, diagnosis-specific survival rates, and patient experience. Forty-six single outcome metrics were identified. Reattendances were the most frequently recommended outcome metrics, with 20 single indicators falling into this category.

Conclusions: The lack of consensus on applicable outcome metrics makes it difficult to evaluate ED performance reliably. This study highlights the need to define and classify more specifically suitable outcome metrics for ED use to justify improvement actions and investigate the effect of healthcare reforms on ED operations.

Registration: PROSPERO CRD42023470855.

Keywords: Benchmarking (MeSH); Emergency department; Emergency medicine (MeSH); Emergency service, hospital (MeSH); Performance evaluation; Performance indicators; Performance metrics; Quality indicators, health care (MeSH).

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Inclusion and exclusion criteria
Fig. 2
Fig. 2
PRISMA Flow Diagram of article selection
Fig. 3
Fig. 3
The most appropriate outcome metric templates for measuring ED performance
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Graff L, Stevens C, Spaite D, Foody J. Measuring and improving quality in emergency medicine. Acad Emerg Med. 2002;9:1091–107. - PubMed
    1. Pines JM, Hilton JA, Weber EJ, Alkemade AJ, Al Shabanah H, Anderson PD, et al. International perspectives on emergency department crowding. Acad Emerg Med. 2011;18:1358–70. - PubMed
    1. Department of Health. The NHS Plan: a plan for investment a plan for reform. https://pns.dgs.pt/files/2010/03/pnsuk1.pdf (2000).
    1. Heyworth J. Emergency medicine-quality indicators: the united Kingdom perspective. Acad Emerg Med. 2011;18:1239–41. - PubMed
    1. Cameron PA, Schull MJ, Cooke MW. A framework for measuring quality in the emergency department. Emerg Med J. 2011;28:735–40. - PubMed

Publication types

MeSH terms

LinkOut - more resources