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Emergency Care for Children: Growing Pains
The committee believes three steps are required to bring accountability into the emergency care system: development of national performance indicators, measurement of performance within communities, and public dissemination of information on system performance.
Development of National Performance Indicators
There is currently no shortage of standards-setting efforts. ED performance measures have been developed by Qualis Health and Lindsay (Lindsay et al., 2002). The Data Elements for Emergency Department Systems (DEEDS) project and Health Level Seven (HL7) are working to develop uniform specifications for ED performance data (Pollock et al., 1998; National Center for Injury Prevention and Control, 2004; Health Level 7, 2005; Personal communication, R.W. Sattin, November 30, 2005). And the ACS and several partners have developed surgical process and outcome measures under the National Surgical Care Improvement Project.
The EMS Performance Measures Project is coordinated by the National Association of State EMS Officials in partnership with the National Association of EMS Physicians, and is supported by NHTSA and the Health Resources and Services Administration (HRSA). The project is working to develop consensus measures of EMS system performance that will assist in demonstrating the system’s value and defining an adequate level of EMS service and preparedness for a given community (EMS Performance Measures Project, 2005). The consensus process of the project has sought to unify disparate efforts to measure performance previously undertaken nationwide that have lacked consistency in definitions, indicators, and data sources. Work undertaken under the project in 2004 resulted in the development of 138 indicators of EMS performance. This list was pared down to 25 indicators in 2005. The list included system measures such as “What are the time intervals in a call?” and “What percentage of transports is conducted with red lights and sirens?” and clinical measures such as “How well was my pain relieved?” The questions were defined using data elements from the National EMS Information System (NEMSIS) dataset so that results could be compared across EMS systems.
In addition, statewide trauma and EMS systems are evaluated by the ACS, HRSA’s Division of Trauma and EMS, and NHTSA’s Office of EMS. There are also various components of the system with independent accrediting bodies. Hospitals, for example, are accredited by the Joint Commission on Accreditation of Healthcare Organizations, ambulance services are accredited by the Commission on Accreditation of Ambulance Services, and air medical services are voluntarily accredited by the Commission on