Emergency Medicine-Quality Indicators: the United Kingdom Perspective

Abstract

During the 1990s, relentlessly increasing emergency department (ED) attendances in the United Kingdom led to major dysfunction and ED overcrowding. The situation was exacerbated by outdated ED design, inadequate ED capacity, traditional ED processes, a predominantly junior doctor-based workforce, and insufficient in-hospital beds for patients requiring admission. The crisis led to high-profile lobbying by the U.K. emergency medicine body (British Association for Emergency Medicine) and in the populist media. This led to the Reforming Emergency Care initiative and the 4-hour target. This article describes the benefits and disadvantages associated with a single time-related measure of ED performance. The article also describes the subsequent development of a raft of quality indicators designed to provide a greater breadth of ED measurement, reflecting timeliness, quality, and safety. The intention is for these indicators to act as levers for change and to generate a program of continuing improvement in emergency care.

Effects of multidisciplinary teamwork on lead times and patient flow in the emergency department: a longitudinal interventional cohort study

“…This effect of multi-professional teamwork on time to physician and total time in the ED is in line with a recent systematic review of interventions aiming at improving processes and patient flow in the ED [9]. Excessive total time in the ED has been linked to poor outcome, and has been suggested as an important quality indicator [20]. Time to physician, as well, has been described as an indicator of quality and safety in the ED, since seeing a decision-maker is a necessity in order to get a prompt assessment and, subsequently, adequate treatment [20].…”

“…Excessive total time in the ED has been linked to poor outcome, and has been suggested as an important quality indicator [20]. Time to physician, as well, has been described as an indicator of quality and safety in the ED, since seeing a decision-maker is a necessity in order to get a prompt assessment and, subsequently, adequate treatment [20]. Hence, our results indicate that teamwork may have a positive impact on these important quality indicators in the ED.…”

Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH

“…Our reattendance rate was well within the limits set by the American Academy of Paediatrics as well as the Department of Health in the United Kingdom. (21) In addition, the admission rate among reattendances was 42.0%. This was higher than the overall admission rate of 16.5% among ED patients at our institution over the same duration, which is a trend seen in most other EDs.…”

Characteristics of patients who made a return visit within 72 hours to the emergency department of a Singapore tertiary hospital

“…(5,6) While rates above 5% may reflect poor-quality care, rates below 1% reflect excessive risk aversion. (7) This implies a need for a more in-depth analysis of the causes of unscheduled 72-hour ED reattendance for policymakers and hospital administrators.…”