Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review

Abstract

Abstract Background: The COVID-19 pandemic severely impacted health systems, leading to care disruptions for non-COVID patients. Performance indicators to continuously monitor acute care, timely reported and internationally accepted, lacked during the COVID-19 pandemic in OECD countries. Methods: Scoping review. Search in Embase and MEDLINE databases. Acute care performance indicators were collected and collated following the care pathway; indicators related to acute general surgery were analyzed separately. Results: A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were collected and collated. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n=41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n=61;75%). Concerning care provided in the emergency department, most of the indicators (n=752;71%) showed a decreasing trend in admissions, across all levels of urgency (n=26, 51% of highly urgent/level 1 indicators; n=20, 56% of level 2; n=31, 67% of level 3 and 4; and n=43, 78% of non-urgent/level 5 indicators). Indicators assessing the volume of diagnostic and treatment procedures signaled reductions: 65% (n=85) of the indicators and 51% (n=54) of the indicators, respectively. Concerning the mortality rate after admission, most of the indicators (n=23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients reported by most of the indicators (n=50,49%), stability in clinical severity at admission (n=36,53%), and stability in the volume of surgeries (n=14,47%). Most of the indicators (n=28,65%) reported no change in treatment approach and stable mortality rate (n=11,69%). Conclusions: This review summarizes the performance indicators available in the literature to assess the quality of acute care in OECD countries and their trends during the first year and a half of the COVID-19 pandemic (2020-July2021). These results highlight the relevance of assessing the acute care pathway more regularly and systematically across different clinical entities, to monitor care disruptions and improve the resilience of emergency services to crises.