Selection and validation of quality indicators for the Shorter Stays in Emergency Departments National Research Project


  • Peter Jones, FACEM, MSc EBHC (Oxon), MB ChB, Emergency Medicine Specialist, Director; Alana Harper, PGCertMSci, MB ChB, Emergency Medicine Research Fellow; Susan Wells, FRNZCGP, FNZCPHM, FAFPHM, PhD, MPH, DipObs, MB ChB, Senior Lecturer; Elana Curtis, FNZCPHM, FAFPHM, MPH, MB ChB, BHB, Senior Lecturer Medical, Academic Directorship of Certificate in Health Sciences, Maori and Pacific Admission Scheme and Whakapiki Ake (Maori recruitment); Peter Carswell, PhD, MCom, BSc, Senior Lecturer; Papaarangi Reid, FNZCPHM, Dip ComH, Dip Obs, MB ChB, BSc, Tumuaki and Head of Department; Shanthi Ameratunga, FNZCPHM, FAFPHM, FRACP, PhD, MPH, Dip Obs, MB ChB, Deputy Head.

Dr Peter Jones, Department of Emergency Medicine, Auckland City Hospital, Private Bag 92024, Victoria St. West, Auckland 1142, New Zealand. Email:


Objective: Despite the spread of time targets for ED lengths of stay around the world, there have been few studies exploring the effects of such policies on quality of ED care. The Shorter Stays in Emergency Departments (SSED) National Research Project seeks to address this. The purpose of this paper was to describe how the indicators for the SSED study in New Zealand were selected and validated.

Methods: A literature review was used to identify potential indicators. A reference group of 25 key stakeholders from across the health system was convened, with the aims of validating the suggested indicators and to ensure that other candidate indicators were not overlooked. A thematic analysis using a general inductive approach was used to analyse focus group discussions.

Results: The major themes were communication, access, timeliness, appropriateness and satisfaction. The 12 indicators selected after literature review were confirmed and two further indicators added after the thematic analysis. The indicators are: hospital and ED length of stay; re-presentation within 48 h; mortality; times to reperfusion, antibiotics, asthma treatment, analgesia, CT for head injury and to theatre (appendicitis and fractured neck of femur); triage time compliance; proportion who left without being seen; quality of discharge information; and ED overcrowding/access block.

Conclusion: Through literature review and consultation with stakeholders, an evidence-based and clinically relevant set of indicators was compiled with which to measure the effect of the SSED target. This indicator set is consistent with recent international recommendations for measuring quality of care in EDs.