Performance indicators for evaluating and optimising hospital services during COVID-19: a scoping review

To identify which logistical and clinical healthcare key performance indicators (KPIs) were applied in hospitals during the COVID-19 pandemic and how frequently they were used when evaluating and optimising hospital care services.

Scoping review reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework.

The search was performed in PubMed, CINAHL, EMBASE, Scopus and Web of Science and included articles published from the beginning of the COVID-19 pandemic, that is, 1 January 2020, until 11 November 2024, the date of the final search. The search strategy combined terms related to (1) COVID-19/pandemic, (2) performance and (3) hospital care.

Eligible studies were peer-reviewed, English-language publications that reported measurable performance indicators evaluating or optimising hospital care services during the COVID-19 pandemic. Studies had to explicitly define or evaluate KPIs and focus on inpatient hospital settings (≥1 overnight stay) in countries within the European Union, the European Economic Area, the Schengen area or the UK. Multicountry or global studies were included when they contained relevant European data or when the geographical context was not determinant (eg, modelling studies). Exclusion criteria included non-peer-reviewed publications, conference abstracts, organisational reports, literature reviews, studies without original results, studies without accessible full text and non-English publications.

Titles, abstracts and full texts were screened independently by three reviewers. Disagreements were resolved through discussion and consultation with two additional reviewers. Relevant study characteristics and KPI-related information were extracted using a predefined data extraction form. KPIs were categorised inductively into thematic categories. Structured data were analysed at both the study and KPI-category level. Data without a predefined structure, such as KPI definitions and key findings, were analysed manually at the KPI-category level.

Across 94 included studies, 459 distinct KPIs were extracted. Given substantial heterogeneity, KPIs were grouped inductively into six main categories: (1) clinical outcomes, (2) resources and capacity, (3) care delivery volumes, (4) care delivery performance, (5) access time and sojourn time and (6) other indicators. KPIs were reported in diverse formats, including volumes, percentages, scores, scales, characteristics and binary outcomes. Identical KPIs were sometimes defined differently across studies, while similar measures were reported under different terminology. The most common reason for KPI use was for the comparison between pre-COVID-19 and COVID-19 periods, followed by supporting optimisation and exploring quality of care during the pandemic. Most studies emphasised either clinical or logistical indicators, with limited integration of both perspectives within a single performance assessment. The majority of KPIs were not pandemic-specific but reflected indicators already used in routine hospital performance monitoring.

Hospital performance during COVID-19 was evaluated using a wide range of heterogeneous KPIs, with substantial variation in definitions and reporting practices. Greater transparency and standardisation in KPI definitions may improve comparability, reproducibility and preparedness for future health crises. Integrating clinical and logistical performance perspectives may provide a broader view of hospital performance and support decision-making during pandemics.