A Systematic Review Of Prehospital Emergency Care Quality Indicators And Their Impact On Patient Outcomes

Abstract

Background: Prehospital emergency medical services (EMS) are a vital entry point into healthcare systems, where timely and high-quality care can directly influence patient survival and recovery. Over the past decade, the scope of EMS quality measurement has expanded from time-only metrics to condition-specific, process-based, and equity-focused indicators. Despite these advancements, the extent to which these indicators translate into improved patient outcomes remains variable.

Objective: This systematic review aimed to synthesize evidence on prehospital emergency care quality indicators, assess their associations with process and patient outcomes, and identify implementation factors that influence their effectiveness.

Methods: A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was conducted for studies published between January 2020 and December 2024. Eligible studies included observational, interventional, and review designs that evaluated EMS quality indicators linked to patient outcomes. Data extraction was performed independently by two reviewers, and findings were synthesized thematically across key domains including response times, stroke, trauma triage, airway management, pain assessment, sepsis, safety indicators, and continuous quality improvement.

Results: Thirty-two studies met the inclusion criteria. Time-based indicators, particularly response intervals in out-of-hospital cardiac arrest, consistently demonstrated strong associations with survival outcomes. Stroke quality indicators—such as last-known-well documentation, glucose checks, validated stroke scales, and prenotification—were linked to shorter imaging and reperfusion times. Structured trauma triage interventions and digital decision-support improved triage accuracy and destination appropriateness. Airway management indicators provided national benchmarks for first-pass success, while pain assessment measures highlighted persistent inequities in treatment. Safety indicators showed that reduced lights-and-sirens use lowered crash risk without delaying care. Prehospital recognition and prenotification of sepsis shortened in-hospital treatment intervals but demonstrated mixed mortality outcomes. Audit, feedback, and continuous quality improvement programs were consistently associated with improved indicator adherence and, in some cases, better patient survival.

Conclusion: Prehospital quality indicators are strongly associated with improved process outcomes and, for certain conditions such as cardiac arrest and stroke, with meaningful patient outcomes. However, gaps remain in risk adjustment, equity-sensitive measurement, and long-term outcomes. Future research should prioritize pragmatic trials and multicenter evaluations to strengthen the evidence base for implementing EMS quality indicators into routine practice.