Key Performance Indicators in the Emergency Medical System: barriers and facilitators

BACKGROUND: Within the EASY-NET research program (NET-2016-02364191), we developed and calculated a set of KPIs on time dependent conditions (trauma, acute myocardial infarction, stroke) to analyse the Emergency Medical System (EMS) of the Friuli Venezia Giulia Region (FVG, 1.2M inhabitants), Italy. The results were returned to health professionals by three annual written reports, a webinar, and a workshop (2019-2023). We aim to describe the major barriers and facilitators to the implementation, use and acceptance of those KPIs in FVG. METHODS: Barriers and facilitators were investigated in 2020 through an online survey (5 questions on the report's clarity, quality, and relevance) e-mailed to doctors and ward managers (Cardiology, Neurology, Intensive Care, Emergency Department) and in 2023 through a debriefing within the research team. RESULTS: The geographical reorganisation of the regional health service and the succession of different political and professional representatives were important barriers, which also made it difficult to have access to raw data. Moreover, metadata were rarely available and several changes in variable coding occurred. In addition, the KPI results were difficult to convey to professionals, especially with a text-only feedback (457 e-mails sent, 71 surveys completed; 21/71 knew the report, 4 had read it). On the other hand, since these were the first KPIs to be calculated on the EMS, professionals collaborated enthusiastically and found them useful (60/71 of the survey responders), the multimodal presentation being the most effective feedback (40 webinar users, 100 workshop participants, despite the pandemic). Last but not least, dealing with data was easier thanks to the unofficial help of former colleagues. CONCLUSIONS: The implementation, use and acceptance of the KPIs are driven by close collaborations, but may be hindered by organisational rearrangements and a difficult access to raw data, especially when metadata are lacking. KEY MESSAGES: • KPIs are well accepted by the EMS professionals, although they are difficult to implement and introduce when political and organisational rearrangements take place. • A difficult access to raw data and the lack of metadata hinder the KPIs’ calculation but close collaborations among data professionals are precious to overcome the problem.