Haniyeh Ebrahimi Bakhtavar
1 
, Zahra Hosseinnajhad
2 , Parvaneh Mahmoudi
3 , Fariba Valizadeh
1 , Farzad Rahmani
4* 1 Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 Hospital Emergency Department Office, Deputy of Treatment, Tabriz University of Medical Sciences, Tabriz, Iran
3 Pre-hospital emergency and disaster management center, Isfahan University of Medical Sciences, Isfahan, Iran
4 Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
Background. The emergency department (ED) is a critical hospital unit that plays a decisive role in patient outcomes and overall health system performance. Regular, systematic evaluation of ED performance is essential for identifying strengths and weaknesses and for strategic planning to improve service quality and patient safety. This study aimed to evaluate the performance of selected EDs affiliated with Tabriz University of Medical Sciences using a validated and reliable checklist.
Methods. This descriptive cross-sectional study evaluated 16 hospital EDs, including all facilities affiliated with Tabriz University of Medical Sciences and six district (Level 1) hospitals. The latter were selected via cluster sampling from populous counties with diverse geographical distributions to ensure provincial representation. The study was conducted from January to March 2025. The assessment tool consisted of a two-part checklist: general ED information and a validated 117-item questionnaire covering nine performance domains. The checklists were completed in person by an expert from the hospital ED department of University’s Vice-Chancellery for Treatment Affairs. Data were analyzed using SPSS version 26. In addition to descriptive statistics,, independent sample t-test was used to compare performance scores by hospital type. The correlation tests were used to assess the relationship between quantitative variables.
Results. The overall performance score of the EDs (out of 100) ranged from "good" to "excellent". Among the 9 domains, "time indicators" (mean score: 89.2±5.1) and "patient-centered care" (mean score: 85.7±7.3) received the highest scores. Conversely, "space and physical facilities" (mean score: 72.4±10.8) and "documentation" (mean score: 75.1±9.5) received the lowest scores. No significant statistical difference was found between general and specialized hospitals, nor was there a significant correlation between performance and the number of beds or annual patient volume (P > 0.05).
Conclusion. Although the overall performance of the studied EDs was satisfactory, the findings highlight a need for targeted interventions in "space and physical facilities" and "documentation". It is recommended that policymakers and ED managers allocate budget for the renovation and optimization of physical infrastructure. Furthermore, implementing continuous training programs for staff regarding the importance and accuracy of clinical documentation is essential for improving service quality.
Research Insight
· The emergency departments (EDs) evaluated in this study attained a satisfactory overall performance.
· Efficiency in "time indicators" and the delivery of "patient-centered care" constitute the primary operational strengths of the studied facilities.
· Significant deficiencies persist in "physical infrastructure and facilities" and "clinical documentation," marking these as the most critical areas for improvement.
· Rectifying these gaps requires strategic capital investment in physical space and continuous professional development focused on the accuracy and importance of clinical documentation.
Expanded Abstract
Background
The emergency department (ED) occupies a critical position within the healthcare system, requiring the rapid and high-quality execution of complex clinical processes. The performance of a hospital’s ED is a primary benchmark for its overall quality of patient care. Despite its importance, comprehensive studies focusing on the systematic monitoring and evaluation of EDs remain limited. This study aimed to evaluate the performance of selected EDs affiliated with Tabriz University of Medical Sciences using a validated assessment tool. By utilizing this standardized instrument, the study sought to accurately assess provincial ED status and identify specific weaknesses to inform strategic solutions for nationwide hospital evaluation and improvement.
Methods
This cross-sectional descriptive study evaluated the 16 EDs: 10 located in the provincial capital and 6 district general hospitals in the provinces selected through cluster sampling between January and March 2025. To maintain confidentiality and adhere to research ethics, individual hospital names were anonymized. The assessment tool comprised two sections: 1) general ED information, and 2) a validated 117-item questionnaire (Akbari Sari et al.) covering nine domains: management and leadership, human resources, physical space and facilities, medications and medical equipment, guidelines and policies, patient-centered care, clinical documentation, quality and effectiveness of services, and time indicators. Data collection was conducted in person by an ED expert from the university’s clinical affairs office, who completed the checklists through field observations, interviews with head nurses, and review of department documentation. Performance was categorized based on the percentage of total possible points: very poor (0–20%), poor (20–40%), average (40–60%), good (60–80%), very good (80–90%), and excellent (90–100%). Statistical analysis was performed using SPSS version 20. Quantitative data were described using mean (standard deviation) and qualitative data via frequency (percentage). Independent Sample T-test compared performance scores hospital type, while Pearson correlation test assessed relationships between quantitative variables. Significance was set at P < 0.05.
Results
Across the 16 EDs, the average overall score fell within the "good" to "very good" range (>80%). The “time indicators” (mean = 89.2±5.1) and “patient-centeredness” (mean = 85.7±7.3) domains demonstrated the highest performance. In contrast, “physical space and facilities” (72.4±8.10) and “documentation recording” (75.1±9.5) received the lowest scores. Pearson correlation analysis showed no significant relationship between overall performance and annual emergency visit volume (p=0.612, r=0.113). Spearman, Spearman correlation indicated no significant relationship between performance and hospital bed capacity (p=0.333, r=0.259). Analysis of pervasive strengths and weaknesses revealed that "time indicators" and "patient-centeredness" were consistently high across 87.5% and 75% of centers, respectively. Conversely, “physical space and facilities” (68.8%) and “documentation” (50%) were identified as the most frequent areas of relative weakness, indicating a clear need for targeted interventions.
Conclusion
This evaluation confirms that the studied EDs under Tabriz University of Medical Sciences generally operate at a "good" to "very good" level. The primary strengths lie in operational efficiency (time indicators) and patient-centered care. However, the consistent weaknesses found in physical infrastructure and documentation processes present opportunities for improvement. Given the ED's vital role in patient management, policymakers should prioritize short- and long-term strategic planning to address these infrastructure and documentation gaps. Future research should focus on developing quality improvement models tailored to these specific performance domains.
Practical Implications of Research
While overall ED performance is satisfactory, there is a clear mandate for continuous quality improvement across all domains. Specifically, hospital managers should focus on modernizing physical facilities and enhancing human resource management.