Development of performance indicators for systems of urgent and emergency care in the Republic of Ireland. Update of a systematic review and consensus development exercise

Objectives: To develop a set of performance indicators to monitor the performance of emergency and urgent care systems in the Republic of Ireland. Design: This study comprised of an update of a previously performed systematic review and a formal consensus development exercise. The literature search was conducted in PubMed and covered the period 2008 to 2014. The results of the review were used to inform a consensus group of 17 national experts on urgent and emergency care in Ireland. The consensus development exercise comprised an online survey followed by a face-to-face nominal group technique meeting. During this meeting participants had the opportunity to revise their preferences for different indicators after listening to the views of other group members. A final online survey was then used to confirm the preferences of participants. Results: Initial literature searches yielded 2339 article titles. After further searches, sixty items were identified for full-text review. Following this review, fifty-seven were excluded. Three articles were identified for inclusion in the systematic review. These papers produced 42 unique indicators for consideration during the consensus development exercise. In total, 17 indicators had a median of greater than 7 following the meeting and met our pre-specified criterion for acceptable consensus. Discussion: Using this systematic review and nominal group consensus development exercise, we have identified a set of 17 indicators, which a consensus of different experts regard as potentially good measures of the performance of urgent and emergency care systems in Ireland. Pragmatic implications are discussed with reference to three subsequently performed original studies which used some of the indicators