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

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.

Calderón de la Barca-Gázquez JM, Gracia García F, Jiménez Murillo L, Montero Pérez FJ, Quero-Espinosa FB, Roig García JJ