The A&E clinical quality indicators were introduced as part of the NHS Outcomes Framework 2011/2012, developed by the Department of Health in conjunction with the College of Emergency Medicine. The eight indicators have applied to A&E departments since 1 April 2011, and now form part of the Department of Healths acute Trust performance framework.

Previously A&E performance was managed against the time it took from a patient arriving in the A&E department, to the decision to either admit or discharge a patient. The new indicators were introduced to provide clinicians with better information to encourage continuous improvement, leading to better and safer patient care, and to provide information that is easier for patients to understand.

To see a summary of A&E performance

Description of A&E clinical quality indicators

There are five headline measures that A&E departments will be performance managed and improving against:

Indicator two: unplanned re-attendance rate

A patient who returns to the same site (A&E or urgent care centre) within seven days of their original attendance is known as an unplanned re-attender. Patients are encouraged to return to A&E (or urgent care centre) if their condition gets worse, this is particularly relevant in younger patients.

Indicator three: total time in the emergency department

The total time a patient spends in the A&E department is measured from the time of a patient's arrival and registration on to the hospital information system, to the time that the patient leaves the department to return home or to be admitted to the ward bed (this also includes admission to the A&E department observation beds).

Indicator four: left without being seen rate

This refers to patients who 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 six: time to initial assessment

This applies to patients who are brought in by ambulance only and is measured from the time of arrival in the department to the time the ambulance crew hand over the clinical care of the patient to the nursing staff.

Indicator seven: time to treatment

This is measured for all patients, and is the time from arrival in the A&E department to the time when the patient actually sees a doctor or nurse practitioner who will start the treatment for the patients condition.

The five headline measures are supported by the following three supporting measures:

Indicator one: ambulatory care

All A&E departments are developing pathways of care for patients, these pathways will aim to avoid hospital admission, there are two key areas of work at present

1. for patients who have skin infections (Cellulitis) and need antibiotics and
2. for those who have a blood clot in their veins (deep vein thrombosis or DVT). This measure will reflect the number of patients who are able to be treated at home by these improved pathways and processes.

Indicator five: 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 eight: 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. This measure will show the number of patients who have seen a senior doctor. This will be measured twice a year by reviewing patient hospital notes and outcomes.