Designing continuous improvement against A&E clinical quality indicators
The A&E clinical quality indicators, which were introduced in April 2011 to replace the four hour A&E operational standard, are not the goal in themselves but should be utilised to stimulate continuous improvement in care.
By focusing on assessing effectiveness of care, patient experience and patient safety, the clinical quality indicators present a comprehensive and balanced view of care in A&E departments.
The eight indicators are:
- Ambulatory care
- Unplanned re-attendance rate
- Total time spent in the A&E department
- Left without being seen rate
- Service experience
- Time to initial assessment
- Time to treatment
- Consultant sign-off
While initiatives which aim to improve performance against a single indicator without considering the effect on the other indicators should be avoided, there is potential to use the indicators as triggers for continual improvements in local structures and processes in urgent and emergency medicine.
A good design project takes a holistic view of a situation, and sets out with the aim of overall continuous improvement instead of achieving a specified target. In the context of improving the patient experience, quality of care and staff and patient safety, a design project will begin by involving staff and patients in a collaborative research project to establish the current situation and aspirations for change.
Quality and Outcomes Framework (QOF)
Effective from 1 April 2012, NHS Employers and the General Practitioners Committee (GPC) have agreed a number of changes to the quality and outcomes framework (QOF) including the introduction of three new organisational indicators for improving Quality and Productivity which focus on accident and emergency attendances.
GP Practices will have to undertake a review of their patients' A&E attendances by August 2012: "The review will include consideration of whether access to clinicians in the practice is appropriate, in light of the patterns on accident and emergency attendance." In addition, practices must exchange data to conduct external peer reviews, agree an action plan with the Clinical Commissioning Group (CCG) and implement it before April 2013. The review may include proposals to improve access to the practice or plans to redesign services or commission new ones.