Accurate and efficient data collection is crucial for effective evaluation of quality of care. The objective of this study is to compare two methods of data collection used to score quality indicators for musculoskeletal injury management in Emergency departments: prospective observation, and chart audit.
An analysis was undertaken of data collected from 633 patients who presented with a musculoskeletal injury to eight emergency departments in Queensland, Australia in 2016–17. Twenty-two quality indicators were scored using both prospective observation and chart audit data for each occasion of service. Quality indicators were included if they were originally published with both collection methods. Analyses were performed to compare firstly, the quality indicator denominators, and secondly, the quality indicator trigger rates, scored using each collection method. Chi Square statistics were used to identify significant differences.
Prospectively collected data scored quality indicator denominators significantly (p value<0.05) more often than chart audit data for five (22.7 %) of the 22 quality indicators. The remaining 17 quality indicators (77.3 %) showed no statistical differences. When comparing quality indicator trigger rates, 16 (72.7 %) had significantly different results between methods with 12 (54.5 %) scoring higher using prospective data and four (18.2 %) with chart audit data. The remaining six quality indicators (27.3 %) in this comparison showed no significant difference between chart and prospective data.
Quality indicators including aspects of care associated with patient safety, and those relying on clinician written orders or forms were adequately scored using either prospective observation or chart audit data. Whereas quality indicators relying on time-sensitive information, elements of a social history, general physical exams and patient education and advice scored higher using prospective observation data collection.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Australasian Emergency Care
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Organization WH. Quality of care 2022 [accessed 23 August 2022].
- National Health and Medical Research Council. NHMRC levels of evidence and grades for recommendations for developers of guidelines. Working to build a health australia Australian Government, 2009:1–23.
- A comparison of observed versus documented physician assessment and treatment of pain: the physician record does not reflect the reality.Ann Emerg Med. 2008; 52 (doi:10.1016/j.annemergmed.2008.01.004[published Online First:2008/03/15]): 383-389
- Retrospective studies and chart reviews.Respir Care. 2004; 49: 1171-1174
- How valid are medical records and patient questionnaires for physician profiling and health services research?: A comparison with direct observation of patient visits.Med Care. 1998; 36: 851-867
- Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects.J Clin Epidemiol. 2014; 67 (doi:10.1016/j.jclinepi.2013.08.015[published Online First:2013/11/28]): 267-277
- Improving trauma documentation in the emergency department.J Trauma Nurs. 2014; 21 (doi:10.1097/JTN.0000000000000071[published Online First:2014/09/10]): 238-243
- The quality in Australian health care study.Med J Aust. 1995; 163: 458-471https://doi.org/10.5694/j.1326-5377.1995.tb124691.x
- Concordance between medical records and observations regarding information on coordination of care.Med Care. 1979; 17: 758-766https://doi.org/10.1097/00005650-197907000-00006
- National project seeking to improve pain management in the emergency department setting: findings from the NHMRC-NICS national pain management initiative.Emerg Med Austral. 2013; 25 (10.1111/1742-6723.12022[published Online First:2013/04/09]): 120-126
- Variables associated with completeness of medical record documentation in the emergency department.Emerg Med Austral. 2019; 31 (doi:10.1111/1742-6723.13229[published Online First:2019/01/29]): 632-638
- How to limit the burden of data collection for quality indicators based on medical records? The COMPAQH experience.BMC Health Serv Res. 2008; 8 (10.1186/1472-6963-8-215[published Online First:2008/10/23]): 215
- Defining and classifying clinical indicators for quality improvement.Int J Qual Health Care. 2003; 15: 523-530https://doi.org/10.1093/intqhc/mzg081
- Musculoskeletal injury quality outcome indicators for the emergency department.Intern Emerg Med. 2020; 15 (doi:10.1007/s11739-019-02234-w[published Online First:2019/11/28]): 501-514
- Process quality indicators for musculoskeletal injuries in the emergency department.Emerg Med J. 2019; 36: 686-696https://doi.org/10.1136/emermed-2019-208531
- Higher quality of care in emergency departments with physiotherapy service models.Emerg Med Austral. 2022; 34 (doi:10.1111/1742-6723.13868[published Online First:2021/10/08]): 209-222
- Improving documentation using a real-time location system in a pediatric emergency department.Appl Clin Inform. 2021; 12 (doi:10.1055/s-0041-1730028[published Online First:2021/05/28]): 459-468
- Non-traumatic musculoskeletal pain in Western Australian hospital emergency departments: a clinical audit of the prevalence, management practices and evidence-to-practice gaps.Emerg Med Austral. 2019; 31 (doi:10.1111/1742-6723.13305[published Online First:2019/05/16]): 1037-1044
- The accuracy and completeness of data collected by prospective and retrospective methods.Acad Emerg Med. 2005; 12 (doi:10.1197/j.aem.2005.04.021[published Online First:2005/09/06]): 884-895
- Concordance between electronic clinical documentation and physicians' observed behavior.JAMA Netw Open. 2019; 2 (10.1001/jamanetworkopen.2019.11390[published Online First:2019/09/19])e1911390
- Evaluation of red flags minimizes missing serious diseases in primary care.J Fam Med Prim Care. 2018; 7 (doi:10.4103/jfmpc.jfmpc_510_15[published Online First:2018/08/10]): 315-318
- Australian Institute of Health and Welfare. Emergency department care activity Canberra: Australian Government; 2021 [accessed 12/8/2022] 2022.
- Strategies for improving physician documentation in the emergency department: a systematic review.BMC Emerg Med. 2018; 18 (doi:10.1186/s12873-018-0188-z[published Online First:2018/12/19]): 36
- Evaluation of a multifaceted intervention on documentation of vital signs at triage: a before-and-after study.Emerg Med Austral. 2013; 25 (doi:10.1111/1742-6723.12153[published Online First:2013/12/07]): 580-587
- Electronic nursing documentation interventions to promote or improve patient safety and quality care: a systematic review.J Nurs Manag. 2019; 27 (doi:10.1111/jonm.12727[published Online First:2018/11/06]): 491-501
Published online: September 22, 2022
Accepted: September 7, 2022
Received in revised form: August 29, 2022
Received: May 23, 2022
© 2022 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.