A&E clinical quality indicators

The A&E clinical quality indicators were introduced as part of the NHS Outcomes Framework 2011/2012 having been developed by the Department of Health in conjunction with the College of Emergency Medicine.  The suite of eight mandatory indicators are applicable from 1 April 2011, and form part of the Department of Health’s Acute Trust Performance Framework from quarter two onwards.

The A&E clinical quality indicators were introduced to:

  • Create a more balanced view of performance that measures patient safety and clinical effectiveness  as well as time measures
  • Encourage a spirit of continuous improvement with better information leading to better clinical outcomes and patient experience
  • Provide information that is easier to understand for patients

Imperial College Healthcare NHS Trust has three (type 1) A&E departments, each of which have an integrated urgent care centre (type 3) on site. The Trust also has a type 2 specialist ophthalmological A&E department at the Western Eye hospital. 

Our teams are committed to providing high quality care for our local patients and specialist services. The A&E teams work closely with colleagues across the Trust, GPs, the London Ambulance Service, mental health services, various patient networks and commissioning colleagues on a daily basis. Over the last six months we worked with partners to draw up improvement plans to ensure each of our units will meet the A&E clinical quality indicators.

The A&E clinical quality indicators
The five headline measures are:

  • Indicator 2: Unplanned re-attendance rate
  • Indicator 3: Total time in the emergency department
  • Indicator 4: Left without being seen rate
  • Indicator 6: Time to initial assessment
  • Indicator 7: Time to treatment

The three supporting indicators are:

  • Indicator 1: Ambulatory care   
  • Indicator 5: Service experience
  • Indicator 8: Consultant sign-off

Description of A&E clinical quality indicators

  • Indicator 2: Unplanned re-attendance rate
    Patients who return to the same site (A&E or urgent care centre) within seven days of the original attendance are known as an ‘unplanned reattender’. Patients are encouraged to return if their condition gets worse, particularly in younger patients, and this figure also depends on the provision of primary or urgent care in the community.
  • Indicator 3: Total time in the 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 the ward bed (including the A&E department observation beds).
  • Indicator 4: Left without being seen rate
    Patients may sometimes leave the department without waiting to be seen – particularly if there is a long wait for a doctor or if the patient has been advised on alternative sources of care.
  • Indicator 6: 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 ambulance crew hand the clinical care of the patient to the nursing staff.
  • Indicator 7: Time to treatment
    Measured for all patients, this is the time from arrival to seeing a doctor or nurse practitioner who will start the treatment for the patient’s condition.

The three supporting indicators are:

  • Indicator 1: 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.
  • Indicator 5: Service experience
    One of the key measures of the service quality is the experience of the patient – and 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.
  • Indicator 8: 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.

The Trust has developed and implemented a number of active projects to deliver improvements against the measures. The performance against the measures will be published on the Trust website every month together with information about improvements achieved and further work planned.

Please use the following links to see the performance indicator charts for Charing Cross Hospital, Hammersmith Hospital and St Mary's Hospital. Each of these pages features a road map which provides a summary of the site with their patient pathway and performance on the A&E clinical quality indicators in August 2011.