Dashboard to support emergency department management

Abstract

Emergency departments are complex, high-pressure settings that must deliver rapid, accurate and safe care to patients with widely varying levels of acuity, often under severe resource constraints. Dashboards have been proposed as decision-support tools to mitigate overcrowding and improve operational performance in healthcare This study aimed to identify and reach expert consensus on a set of key performance indicators and requirements for a real-time dashboard tailored to the context of Portuguese emergency departments. A two-round modified Delphi panel was constructed with experts, including emergency department clinicians, nurse managers, hospital administrators, and health information specialists. In Round 1, participants rated the relevance of operational and strategic indicators via a five-point Likert scale, complemented by open-text suggestions. Indicators that did not reach consensus (≥80% agreement) were reassessed in Round 2. Twenty-two experts participated in round 1 and 19 in round 2. In Round 1, consensus (≥80% agreement) was achieved on 48 of the 68 indicators (71%): 11 real-time operational metrics, 8 strategic performance indicators, and 29 system functionalities. Strong support emerged for leadership-focused dashboard access, role-specific dashboard visualization, and alerts for overcrowding, triage breaches, diagnostic delays, and bed shortages. The main barriers identified were high costs and inadequate technological infrastructure. This study identified and prioritized a nationally relevant framework of indicators and requirements for an emergency department dashboard providing a practical foundation to guide future optimization of patient flow, resource allocation, and safety in Portuguese emergency departments. The findings provide a foundation for pilot implementation in real-world settings, with future integration of predictive analytics and interoperability across health information systems. This study used a two-round modified Delphi design to achieve national consensus among multidisciplinary experts on emergency department dashboard indicators and requirements. The inclusion of professionals from multiple Portuguese Local Health Units and diverse professional roles enhanced representativeness and contextual relevance. A predefined ≥ 80% agreement threshold and retention rate of 86% ensured methodological rigor, transparency, and stability across Delphi rounds. The fully online, anonymous design promoted independent reflection and minimized group pressure, while combining quantitative and qualitative feedback allowed comprehensive analysis. The voluntary nature of participation and the purposive sampling approach may limit generalizability to all Portuguese emergency departments. • Overcrowding and prolonged waiting times remain critical threats to quality and safety in emergency departments worldwide. • Dashboards have been proposed as real-time decision-support tools that consolidate key performance indicators and alert clinicians to bottlenecks. • Previous studies seldom combine operational and clinical metrics in a single, hybrid dashboard, and evidence generated in the Portuguese healthcare context is nonexistent. • A two-round modified Delphi panel involving 22 Portuguese experts in Round 1 and 19 in Round 2 achieved national consensus on emergency department indicators. • Highlights user-centered requirements, such as drill-down to patient-level data, automatic data refresh, and interoperability with existing hospital information systems, which are often overlooked in the dashboard literature. • Research: This study provides a consensus-based, context-specific indicator set and a replicable Delphi framework for future multicenter studies assessing emergency department performance or testing crowding interventions. • Practice: Delivers an evidence-based blueprint for Portuguese hospitals to design or upgrade emergency department dashboards, with the potential to reduce waiting times, optimize resource allocation and enhance patient safety and satisfaction. • Policy: This study contributes to the development of digital health public policies by identifying priority needs in system integration, indicator standardization, and data governance within emergency care settings, thereby guiding strategic decisions and sustainable investments in the modernization of hospital information systems.