Clinical Quality Indicators

The Department of Health introduced five new headline accident and emergency  (A&E) clinical quality indicators from the 1 April 2011 with three supporting measures.

The five headline measures are:

A&E admission

Unplanned re-attendance rate – Patients who return to A&E within seven days of the original attendance are classed as an unplanned reattendance if they have not been specifically asked to re-attend.

Total time in the  accident and emergency department– This is measured from the time of arrival and registration on the hospital information system to the time that the patient leaves the department to return home or to be admitted to a ward bed.

A&E reception

Left without being seen rate– Patients who have registered but leave the department without waiting to be seen by a clinician.

Time to initial assessment – This applies only to patients who are brought in by ambulance and is measured from the time of arrival in the department to the time the patient has an assessment by the clinical team.

Time to treatment – This is the time from arrival for all patients to seeing a doctor or nurse practitioner who will start the treatment for the patient’s condition.

The three supporting indicators are:

Ambulatory care – A&E departments are developing pathways of care for patients to avoid hospital admission and the two key areas of work at present are for patients who have skin infections and need antibiotics and for those who have a blood clot in their veins. The measure will reflect the proportion of patients who are able to be treated at home by these improved pathways and processes.

Service experience – One of the key measures of the service quality is the experience of the patient. Trusts will be reporting the results of patient surveys as well as giving information about specific projects designed to provide a better experience or outcome for the patients overall.

Consultant sign-off – While it is not possible or necessary for every patient to be seen by a consultant in A&E, there are certain conditions where the outcome can be improved by a senior doctor being involved in the case. The measure will demonstrate the proportion of those patients who have seen a senior doctor and will be measured twice a year by detailed review of notes and outcomes.