Measuring more than mortality: a scoping review of air ambulance outcome measures in a combined Institutes of Medicine and Donabedian quality framework

Edwards, Kristin H., FitzGerald, Gerard, Franklin, Richard C., and Edwards, Mark Terrell (2021) Measuring more than mortality: a scoping review of air ambulance outcome measures in a combined Institutes of Medicine and Donabedian quality framework. Australasian Emergency Care, 24 (2). pp. 147-159.

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Measuring the performance of air ambulance services are complex and dynamic due to the variability and interconnectedness of emergency systems. The aim of this study is to review the range and nature of air ambulance outcome measures published in peer review articles and construct a quality framework based on the results. A scoping review of the literature was conducted to identify outcome measures that evaluate the quality of air ambulance services. Combined frameworks from the Institutes of Medicine (IOM) and Dr. Avedia Donabedian were used to create a dashboard structure for a framework of air ambulance outcome measures.


A literature search strategy was undertaken, following PRISMA-ScR guidelines and included eight databases over the period 2001-2019. Qualitative content analysis was conducted in 4-phases: 1) table summary of selected article outcome measures, 2) content analysis themes, codes of outcome measures and independent variables 3) narrative description of main themes 4) visual dashboard diagram of service priorities and quality strategies, based on the findings.


Thirty-four articles were screened by full text and eighteen met the selection criteria. Twenty codes emerged and were grouped to form eight consistent outcome themes; asset/ team type, access to definitive interventions, prehospital factors, mortality, morbidity, responsiveness of service, accessibility of service and patient disposition.


A quality framework consisting of eight outcome measures was created, it also identified seven gaps which ordinarily require performance evaluation; patient comfort and satisfaction reporting, cultural awareness training, safety alarms in place to identify volume stress, optimal coordination of resources, cost of service analysis, comprehensive patient journey time and an adaptive referral system analysis. The measures in the framework provide a broad perspective of air ambulance performance we believe will help decision-making and planning to improve patients experience and outcomes.

Item ID: 67335
Item Type: Article (Research - C1)
ISSN: 2588-994X
Keywords: Air ambulance; Quality measures; Service delivery; Institutes of Medicine; Donabedian and quality framework
Copyright Information: © 2020 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
Funders: Emergency Medicine Foundation (EMF) Australasia, Central Queensland Hospital and Health Service (CQHHS)
Projects and Grants: EMF EMPJ-370R27
Date Deposited: 17 Mar 2021 09:48
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420309 Health management @ 100%
SEO Codes: 20 HEALTH > 2003 Provision of health and support services > 200311 Urgent and critical care, and emergency medicine @ 100%
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