Emergency Medicine International / 2012 / Article / Tab 1

Review Article

Measuring Quality in Emergency Medical Services: A Review of Clinical Performance Indicators

Table 1

Structure-Process-Outcome Model for EMS systems PIs.

Indicator TypeDefinitionsEMS systems PI examplesAdvantagesLimitations

StructureCharacteristics of the different components of the system(i) Facilities
(ii) Equipment
(iii) Staffing
(iv) Knowledge base of providers
(v) Credentials
(vi) Deployment
(vii) Response times
(i) Standardized structural data allows for comparison between systems structure(i) Indirect measure of quality
(ii) Difficult to relate to outcome
(iii) Problematic with EMS system design diversity

ProcessCombination or sequence of steps in patient care intended to improve patient outcome(i) Medical protocols
(ii) Medication administration
(iii) Transport to appropriate facility
(i) Direct measure of quality
(ii) Specific input for improvement
(iii) Easy to understand and to evaluate
(iv) Does not require Risk adjustment
(v) Easy data collection
(vi) Best for technical skill evaluation
(vii) Short-term evaluation
(i) Strict criteria for generalization
(ii) Can become very complex with more advanced care (i.e., complex processes)

OutcomeChanges in health and well-being related to antecedent care 6 D’s*
(i) Death
(ii) Disease
(iii) Disability
(iv) Discomfort
(v) Dissatisfaction
(vi) Destitution
(i) Out of hospital cardiac arrest survival
(ii) Patient Satisfaction
(iii) Improvement in pain score
(i) Easy to understand
(ii) Feedback about all aspects of care provided
(iii) Long-term outcomes
(i) Indirect measure of quality
(ii) Requires Risk adjustment and standardization of data collection

*EMS outcomes defined by Emergency Medical Services Outcomes Project (EMSOP).

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