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  1. Determination of service key performance indicators for emergency departments of teaching hospitals in Malaysia: A fuzzy delphi method
    Nik Hisamuddin NAR, Normalinda Y, Abu Yazid MN, Mimi Azliha AB, Andey R, Mohd Hashairi F, et al.
    Med J Malaysia, 2021 Nov;76(6):792-798.
    PMID: 34806662
    INTRODUCTION: The most crucial step in forming a set of key performance indicators (KPI) for emergency department's (ED) staff is deciding the appropriate items for the KPI. This article demonstrates Fuzzy Delphi Method (FDM) as a scientific approach to consolidate consensus agreement within a panel of experts pertaining to each service related KPI item's appropriateness for ED. We aimed to develop framework of service key performance indicators for emergency departments of tertiary centres by using FDM.

    MATERIALS AND METHODS: The panel consists of ten experts from ED that was randomly chosen from list of specialists obtained from the National Specialist Registry for Emergency Medicine. A set of questionnaires that contains item constructs related to KPI based on structure, outcome and process was developed from initial literature search from Pubmed Central, Google Scholar, Cochrane Database and Public Library of Sciences. The construct then used for FDM session in second phase of the study. In FDM phase, the experts will rank each of the items created from nominal group technique (NGT) session by using Likert Scale ranged from 1 to 5 ("1" totally disagree and "5" extremely agree). FDM prerequisite must include threshold value (d) ≤0.2, expert consensus of >75% and average fuzzy numbers ("A" value) of >0.5.

    RESULTS: The initial item construct has produced 22 items proposed for the service KPI. Post FDM analysis for service KPI, 16 out of the 22 (72%) satisfied first prerequisite "d" value ≤0.2. For the second prerequisite, ten items (45%) from service KPI domain had expert consensus of more than 75%. For the third prerequisite, 16 out of the 22 (73%) fit the criteria of average fuzzy number ("A" value) of more than 0.5. In final model of FDM, 13 items (59%) were discarded and the remaining (n=9 items) that fulfilled all three prerequisites were retained for the final draft for content validation process.

    CONCLUSION: This study introduces that FDM can be used to obtain experts' opinion and consensus in order to achieve a decision. The experts' consensus on the suitability of the pre-selected items on the KPI set were obtained, hence it is now ready for further applicability in the clinical setting in ED.

  2. Fulltext A Survey on the Choice of Transportation to come to Emergency Department among Patients with Acute Coronary Syndrome of A Community in Malaysia
    Chew KS, Wan Masliza WM, Nik Hisamuddin NA, Mohd Hashairi F, Shaik Farid AW, Tuan Hairulnizam TK, et al.
    Med J Malaysia, 2015 Feb;70(1):6-11.
    PMID: 26032522 MyJurnal
    BACKGROUND: Good coronary care begins from the patient's home, including early transportation. As such, it is recommended that the patients activate ambulances, rather than to use their own transportations to reach the hospitals. It is not known whether Malaysian patients prefer to use private transportations or ambulances when they develop chest pain.

    OBJECTIVES: This study is conducted to explore the question of the choice of transportation modes among patients with acute coronary syndrome and the reasons behind their choices.

    METHODS: This is a structured interview survey on patients diagnosed with acute coronary syndrome (ACS) in emergency department of Hospital Universiti Sains Malaysia from April 2012 to September 2012.

    RESULTS: Out of the 110 patients surveyed, 105 (95.5%) patients chose to use own transportation when they developed symptoms suggestive of ACS. Only 3 patients (2.7%) came to the emergency department within 1 hour of onset, and all these 3 patients chose to use ambulances as their modes of transportation. None of the patients who chose own transportation came within the first hour of symptoms onset. This is shown to be statistically significant (p<0.001). The level of education as well as past history of ischemic heart disease did not significantly influence the patients' choice of transportation.

    CONCLUSION: The admonishment by various international resuscitation councils that patients with chest pain should be transported via ambulances may not be as straightforward as it seems. Numerous local and regional socio-cultural and logistic factors may need to be addressed.
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