Quality Indicators in the ED

Announced in 2010, implemented from April 2011.


  1. Ambulatory Care

Initially focused on


Deep vein thrombosis

Both these conditions had >60% potential to avoid admission if used appropriately

Review and assess the way we manage these cases and attempt to embed ambulatory care into departmental practice


Liaison with medicine if they already have a dedicated ambulatory care area

Correctly classifying the patients who reattend eg for abx for cellulitis


  1. Unplanned re-attendance

Should be between 1-5%

  1. Total time spent in the ED

Should be <95%

The single longest wait should be no more than 6 hours – this includes patients waiting for a level 1 bed

  1. Left without being seen

>5% is an area of risk, patients who leave the ED before the required detailed formal clinical process is completed are known to be at risk of adverse events


  1. Service experience

will look at – steps which have been taken regularly to assess experience of the ED or UCC

  • what has been done to improve services
  1. Time to initial assessment

Full initial assessment for cases arriving by ambulance – should be within 20 mins of arrival or handover by ambulance crew


  1. Time to treatment

Should not be >60 mins, median time reported

Rate of missing data should be <5%

***Avoid use of hello clinician who adds little value ***

Should not use junior staff who lack the experience to make definitieve clinical decisions

Avoid excessive front loading


  1. Consultant sign off

This now includes 4 main groups

Chest pain in >30 yr olds

Febrile illness in <1 yr old

Abdominal pain in adults >70 years old

Unscheduled returns (with the same complaint) within 72 hours


How can we achieve these?