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Balanced scorecard management of a hospital emergency department

Montero-Pérez FJ, Calderón De La Barca Gazquez JM, Jiménez Murillo L, Quero-Espinosa FB, Gracia García F, Roig García JJ

Unidad de Gestión Clínica de Urgencias, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain.

We report the design of a balanced scorecard for managing an emergency department
in a tertiary care university teaching hospital; data derived by implementing the
scorecard system are also presented. The project was carried out in the following phases:
1) selection of indicators of activity and quality of processes and outcomes for the
scorecard, 2) validation of the indicators, 3) analysis of indicators from 2007 through
2009, and 4) conclusions regarding clinical performance in relation to the indicators that
make up the scorecard. For 2009, we analyzed 124 720 emergencies. The mean wait
time before triage was 5.2 minutes; 31.7% of the patients waited longer. Triage took a
mean of 1.5 minutes; triage took longer for 1.0% of the emergencies. Emergencies with
a wait time of longer than 5 minutes before triage were distributed bimodally, with
peaks at 11 A.M. to 12 noon and from 4 P.M. to 5 P.M. The rate of staff reassignments
was 4.8%, and 2.8% of patients were lost. Among noncritical cases, 41.2% exceeded
the maximum wait time before physician contact. The overall mortality rate was 0.24%.
We conclude that a customized balanced scorecard approach allows an emergency
department to manage relevant time intervals and adapt them to care standards, among
other advantages of the system. The scorecard sheds light on how a department actually
works and encourages the adoption of corrective measures based on analysis of results.

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