ContextAn emergency department (ED) in a hospital provides 24-hour care for the injured/severely ill patients. EDs are essential in any health care system. However, they face many challenges to provide timely treatment such as shortage of specialists, inadequate infrastructure, and unavailability of hospital beds, among others. These challenges are worldwide and undermine the effectiveness of operations and quality of services throughout the hospital. MethodsThis study aims to improve the performance of EDs using key performance indicators (KPIs). The KPIs will help decision makers to monitor and manage the performance of EDs systematically. Based on an in-depth field study, expert opinions, and literature review, we propose 5 categories of KPIs regarding Capacity for, Temporality of, Quality of, Outcomes of, and Economics of emergency care. The KPIs are applicable to the basic stages of emergency care. The achievement of the KPIs in each stage will be a function of (1) how the KPIs are used, (2) resources for achieving the KPIs, and (3) management of the resources. The unified systemic framework to manage EDs is presented as an ontology that articulates the very large number of potential ways of ED performance management. ResultsSeventy-five KPIs were defined for monitoring purposes. The KPIs and the proposed framework were validated and applied in 2 EDs at a public children's hospital and a medium size clinic in Chile. ConclusionsBased on the study, we propose to standardize the essential information necessary to assess the performance of EDs in Chile using KPIs for their continuous improvement.