Evaluation of the Quality of Care in the Emergency Department by Studying the Appropriateness of Hospitalizations

Primary outcomes

1. Qualitative validation and first refinement of the classification algorithm

   Time frame: From August 2025 to November 2025

   In this first phase of the project, representatives of doctors and nurses from participating hospitals will be asked to express their opinion on content validity. This refers to the accuracy with which a measurement tool covers all aspects of the construct under examination. Its measurement is generally based on the judgment of experts in the field, who are asked to provide feedback on how closely the measurement tool corresponds to the different domains associated with the construct.

   The evaluation will be conducted according to the consensus conference approach, an approach that reduces the risk of excessive subjectivity, intrinsic to content validity. This evaluation will lead to a possible refinement of the individual criteria that make up the algorithm.

2. Quantitative validation and second refinement of the classification algorithm

   Time frame: From September 2025 to October 2026

   In this second phase, the criterion validity of the algorithm developed in the previous phase will be examined. Criterion validity measures the relationship between the results obtained with the test in question and those obtained with a consolidated reference standard (the criterion, or gold standard) that measures the same construct.

3. Application of the algorithm to all eligible patients

   Time frame: From November 2026 to Dicember 2026

   Once perfected, the algorithm will be applied to all eligible patients arriving at the ER of participating hospitals within a 24-month period (from January 2023 to December 2024). This means that, for all hospitalized patients, it will be possible to obtain data on the appropriateness of this choice and monitor the evolution of this data over time.

4. Feasibility of assessing the appropriateness of discharge from the emergency room

   Time frame: From November 2026 to June 2027

   In this phase, an attempt will be made to obtain the data necessary to evaluate the appropriateness of discharges from the ED for eligible patients who were discharged between January 2023 and December 2024. Data will be collected on all accesses in the period considered in order to identify any multiple patient accesses (return visits) and the related presentation tables.