Do the national performance tables really indicate the performance of accident and emergency departments?

Abstract

In order to qualify for inclusion in the performance tables, a survey of at least 5% of new patients attending in a three month period had to be performed. The guidelines stipulate that time of arrival must be the time the patient first enters the department. Where the Audit Commission's auditors judged the data collection systems to be satisfactory, star ratings have been allocated. Only 186 units have been awarded a star rating. The star ratings are presented in the form of league tables, and claim to "show performance at a glance". One star means that less than 80% of patients were assessed immediately they arrived in the department, two stars mean 80-84%, three stars 85-90%, four stars 90-94%, and five stars 95% or more.

The dysfunctional consequences of a performance measurement system: the case of the Iranian national hospital grading programme

“…Similar findings have been reported in other countries. 23,35 Such behaviours in Iranian hospitals may thus erode trust in the system.…”

The Emergency Severity Index Triage Algorithm Version 2 Is Reliable and Valid

“…35 This work produced a series of provocative letters and papers and raised questions about decisions made using triage data, including the national performance tables. 8,[36][37][38][39] In 1997 the Manchester Triage Group published its book Emergency Triage to establish a national triage scale for the UK. 15 The NHS soon thereafter adopted the MTS as developed by the Manchester Triage Group to be used by all NHS A & Es.…”

An overview of triage in the emergency department

“…The need was for rapid, accurate sorting of patients, differentiating those requiring immediate medical care from those who could wait after initial assessment and first aid before being evaluated and treated. Although triage was used in many emergency departments there was no available evidence demonstrating its benefits and there was no standardisation of the process (George et al 1992, Edhouse andWardrope 1996). A Assessment and identification of the patient's problem based on the subjective and objective findings and considering any relevant social factors.…”