Physical structure, human resources, and health care quality indicators in public hospital emergency departments in the autonomous communities of Madrid and Catalonia: a comparative study

Objective.

To compare the general, structural, and organizational characteristics of public hospital emergency departments in the Spanish autonomous communities of Madrid and Catalonia.

Methods.

Descriptive survey-based study covering 3 areas of inquiry: general hospital features (18 questions), structural features of the emergency department (14 questions), and organizational and work-related policies of the emergency department (30 questions). Hospitals were grouped according to complexity: local hospitals (level 1), high-technology

or referral hospitals (levels 2–3).

Results.

We studied 26 hospital departments in Madrid (21, levels 2–3; 5, level 1) and 55 in Catalonia (24, levels 2–3; 31, level 1). Hospitals in Madrid are in newer buildings (P=.002), have more beds on conventional wards and in critical care units (P<.001, both comparisons), are more often affiliated with a university (P<.001), and serve larger populations (P=.027). The emergency departments in Madrid have larger surface areas available for clinical care and more cubicles for preliminary evaluations and observation beds (P=.001, all comparisons). Hospitals in Madrid also attended a larger median number of emergencies (P<.001). More physicians were employed in Catalonia overall, but the numbers of physician- and nurse-hours per hospital were higher in Madrid, where it was more usual for physicians to work exclusively in the emergency department (92.5% in Madrid vs 56.8% in Catalonia, P<.001). However, fewer of theemployed physicians had permanent contracts in Madrid (30.5% vs 75.1% in Catalonia, P<.001). The ratio of resident physicians to staff physicians differs between the 2 communities on afternoon/evening, night, and holiday shifts (3:1 in Madrid; 1:1 in Catalonia).

Conclusions.

The physical and functional structures of hospital emergency departments in the communities of Madrid and Catalonia differ significantly. The differences cannot be attributed exclusively to geographic location.