Date of Award

Summer 2017

Document type


Degree Name

PhD (Doctor of Philosophy)

First Supervisor

Dr Abel Wakai

Second Supervisor

Professor Ronan O'Sullivan

Third Supervisor

Professor Tom Fahey


Health Research Board (HRB) Health Research Award (HRA_HSR/2012/18) award.


Emergency Service, Hospital, Quality Indicators, Feasibility Studies, Health Care



Key performance indicators (KPIs) are specific and measurable elements of health that can be used to assess quality of care. The aim of this study is to determine the feasibility of implementing valid and reliable Emergency Department (ED) KPIs based on currently available ED data-capturing systems.


A systematic literature review was performed to summarise the methods used to identify, develop and/or propose ED KPIs. A comprehensive data dictionary was developed using consensus methodology. A quantitative analysis assessed the current availability of the minimum data set (MDS) elements relevant to 11 ED KPIs in 12 Irish EDs. A cross case analysis study documented the procedures involved in accessing data relevant to ED KPIs. A focus group study determined how current ED data collection systems for relevant MDS elements were integrated into routine service delivery.


There were 1,170 identified ED KPIs, which either were proposed or evaluated using survey, consensus (including modified Delphi expert group techniques) and evaluation methodologies in the 38 included studies. The systematic review highlighted that the quality of the studies to support ED KPIs is weak and that there is little published evidence regarding the feasibility of ED KPIs. A data dictionary was created with 44 included data elements. Overall, 105,982 MDS elements relevant to the 11 KPIs examined were collected and analysed from 9,298 ED clinical records. The overall availability of MDS elements for the included KPIs was 74.66%. The cross case analysis found that it was challenging to access and identify data relevant to ED KPIs within current data management systems. The global theme of “understanding enablers and barriers to improving ED data collections” emerged from the focus group study. The focus group study findings confirmed that the required ED data collection systems for the relevant MDS elements are not currently well integrated into routine service delivery.


This thesis demonstrates that implementation of ED KPIs requires fit-for-purpose information systems aimed at capturing the relevant MDS elements as part of routine service delivery.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.

File Size

8.80 MB


A thesis submitted for the degree of Doctor of Philosophy from the Royal College of Surgeons in Ireland in 2017.

Available for download on Tuesday, June 30, 2020