Feasibility and compliance with quality indicators for pediatric respiratory care in Jordanian emergency departments: A mixed-methods study.

BACKGROUND: Evaluating and improving the quality of care requires efficient and accurate data collection. This study aimed to evaluate the feasibility and compliance of quality indicators (QIs) for pediatric patients with asthma, bronchiolitis, and croup in emergency departments (EDs), to compare QI measurement using prospective direct observation and chart audit, and to explore factors influencing QI feasibility and compliance. METHODS: A mixed-methods study was conducted in two EDs between September and October 2024. The feasibility and compliance of 26 QIs were assessed through prospective observation of ED care for asthma (n = 249), bronchiolitis (n = 91), and croup (n = 147), alongside retrospective chart audits. Semi-structured interviews with nine pediatric residents were conducted to explore factors influencing QI feasibility and compliance. RESULTS: All 26 QIs were feasible during prospective observation, whereas only 16 (61.5%) were feasible using chart audits. Compliance varied across indicators, with consistently higher estimates observed using prospective observation and marked discrepancies for several clinical assessment and treatment indicators. Overuse of radiography and antibiotics was identified across all three conditions. Thematic analysis identified eight themes and 17 subthemes related to documentation practices, workload, and system-level challenges. CONCLUSIONS: QIs based on electronically recorded clinician orders were consistently captured using both methods, whereas those relying on physical assessment and clinical documentation were not reliably captured in chart audits. Compliance was generally acceptable but lower for clinical evaluation and diagnostic indicators, highlighting the need for complementary data collection methods.