Emergency medicine-quality indicators: the United Kingdom perspective

During the 1990s, relentlessly increasing emergency department (ED) attendances in the United Kingdom led to major dysfunction and ED overcrowding. The situation was exacerbated by outdated ED design, inadequate ED capacity, traditional ED processes, a predominantly junior doctor-based workforce, and insufficient in-hospital beds for patients requiring admission. The crisis led to high-profile lobbying by the U.K. emergency medicine body (British Association for Emergency Medicine) and in the populist media. This led to the Reforming Emergency Care initiative and the 4-hour target. This article describes the benefits and disadvantages associated with a single time-related measure of ED performance. The article also describes the subsequent development of a raft of quality indicators designed to provide a greater breadth of ED measurement, reflecting timeliness, quality, and safety. The intention is for these indicators to act as levers for change and to generate a program of continuing improvement in emergency care. The indicators were introduced in England in April 2011, and currently there is a period of bedding-in and collective learning. The quality indicators will be reviewed and refined as required, with any amendments introduced in April 2012.