Objective standards for the emergency services: emergency admission to hospital

The primary objectives of the emergency services are to minimize early mortality and complications, although longer-term morbidity, quality of life and late mortality may also be influenced by early actions. Evaluation of the emergency services and demonstration of quality need to reflect these objectives by appropriate choice of outcome measures. This brief review of leading measures of quality in emergency admissions discusses population-based 30-day mortality, after examining some limitations of 'hospital mortality', incidences of complications, which can be more sensitive measures of quality of care when mortality rates are low, and a role for audit and management, when relationships between process and outcome are clear. As an example, the UK study of urgent admission to hospital, on behalf of the Clinical Standards Advisory Group, showed wide variation between sampled hospitals in timeliness of early clinical actions and a statistically significant association between timeliness and 30-day survival. The review also discusses capacity, a necessary requirement for a quality service, and operations research/queuing theory to facilitate management of capacity/resources to meet fluctuating demands. The NHS should be able to plan for seasonal needs.