Time to initial assessment: this measures the time from arrival at A&E by ambulance to the time when a patient is assessed by an emergency care medical or nursing professional to determine priority for treatment. Arrival is defined as the time when the ambulance crew hand the patient over to the A&E team. We are expected to have seen all patients within 20 minutes and 95% of patients within 15 mins. The aim of this indicator is to reduce the clinical risk associated with the time the patient spends unassessed in A&E.
Unplanned follow-up attendances within 7 days of discharge from A&E for the original attendance. The aim of this indicator is to reduce avoidable re-attendances at A&E by improving the care and communication delivered during the original attendance. High re-attendance figures, anecdotally described as 5% by the department of health, may indicate poor quality care.
Total time spent in the A&E department: This measures the time below which 95% of attendances within the month were admitted, transferred or discharged and is expected to be below 4 hours. Longer lengths of stay in the emergency department are associated with poorer health outcomes and patient experience as well as transport delays, treatment delays, ambulance diversion, patients leaving without being seen, and financial effects.
%age of people who leave without being seen by a clinical decision maker:If a patient leaves A&E, it should be because they have made an informed decision not because they are dissatisfied. Best practice is accepted as having a rate below 5%. The aim of this indicator is to improve patient experience and reduce the clinical risk to patients who leave A&E before receiving the care they need.
Time to treatment: time from arrival to start of definitive treatment from a decision-making clinician, someone who can define the management plan and discharge the patient to diagnose the problem and arrange or start definitive treatment as necessary. The aim of this indicator is to reduce the clinical risk and discomfort associated with the time the patient spends before their treatment begins in A&E. There is no absolute measure as some conditions need a shorter treatment time than other but at least 50% of patients should start a treatment plan within 60 minutes.
This information is published in greater detail in the Department of Health paper. The key pages are pps 32-53. If you find this paper interesting in other respects you probably need to get out more. Follow this link to our page listing activities in the borough to find out how you can do this.