EM · Quality and ED metrics

Quality and ED metrics — performance measurement, the four-hour target and quality improvement

Also known as National Emergency Access Target · NEAT · Four-hour rule · Access block · Emergency department overcrowding · Left without being seen · Plan-Do-Study-Act cycle · Statistical process control · Run chart · Benchmarking · Donabedian framework · Door-to-doctor time · Quality improvement in the ED

Quality and emergency department metrics — the Donabedian structure-process-outcome framework; the National Emergency Access Target (NEAT), the four-hour rule requiring 90 per cent of ED presentations discharged or admitted within four hours; the core ED metrics of time-to-treatment (door-to-doctor, door-to-ECG, door-to-antibiotic, door-to-needle), admission rate, LWBS (left without being seen) rate and mortality; access block (length of stay greater than eight hours for an admitted patient) and overcrowding as the dominant drivers of metric failure and excess mortality (Sprivulis, Guttmann, Howlett, Nicolaidis); the differential of drivers of access block (input, throughput and output factors); quality improvement methodology — Plan-Do-Study-Act, run charts with the probability-based rules for special-cause variation, statistical process control (SPC) Shewhart charts distinguishing common-cause from special-cause variation, and benchmarking against peer departments; and the unintended consequences of the target — gaming, premature discharge and short-stay-unit inflation. ACEM-primary, globally tagged.