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RCN: Trusts 'struggling' with new A&E indicators

  • 3 Comments

Poor quality data on the work of nurses and other accident and emergency clinicians has led the government to change the way it measures performance in accident and emergency.

The government has retreated from plans to fully implement a set of eight performance indicators, which measure for time to initial assessment and time to treatment by a decision-making clinician - two tasks often undertaken by nurses. The indicators replaced the four hour A&E standard in April.

Trusts were originally expected to be meeting the minimum threshold for five of the eight new indicators, which were developed with advice from the Royal College of Nursing, by 1 July.

However, due to concerns about the quality of data on the new indicators, trusts will for the time being have to meet only two - one on timeliness and one on patient impact, and will have to continue meeting the four hour A&E standard.

National clinical director for urgent and emergency care, Professor Matthew Cooke, said this was because the Department of Health knew the data on the four hour standard “worked”.

He told Nursing Times data on time to initial assessment, the most nurse-led indicator, which requires all patients arriving by ambulance to be given a full assessment including a pain score and a physiology assessment within 20 minutes had been particularly unreliable, making it “impossible to tell how trusts are doing”.

Royal College of Nursing adviser on acute and emergency care Alan Dobson said trusts had been “struggling” with the new indicators but he welcomed their focus on quality and safety.

“The indicators are trying to make sure the right thing is done at the right time, with the right people assessing people adequately, not waiting until four hours 55 minutes then worrying about the target,” he added.

  • 3 Comments

Readers' comments (3)

  • “The indicators are trying to make sure the right thing is done at the right time, with the right people assessing people adequately, not waiting until four hours 55 minutes then worrying about the target,”

    Can I assure Alan that nothing has changed - the clock still ticks until 3 hours 55 minutes and then we worry about where to send the patient so they don't breach. Indeed it's my often my game for the day plus a wee bit of ad hoc nursing care. More staff and better trained nurses would of course change this overnight. Funny old world Alan - I'm still doing the job of two people a decade after qualifying - a strange way we go about treating the sick and infirm in this country. Actually barbaric, though I'm sure no KPIs measure that.

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  • This is ridiculous.

    I am in favour of the seven clinical CQIs as they do give a better measure of quality than the single four hour target.

    Unfortunately the data from the four hour target does NOT work, despite what the dept of health may think, as at 239 minutes everyone was discharged from the ED irrespective of where the patient was on their treatment curve, thus the data obtained is statistically unsound.

    There has been enough time for trusts to implement the necessary procedures to ensure compliance with all eight CQI, there is nothing difficult about them or their implementation. The only thing stopping this is the inertia of the trusts themeselves because there are implications on the systemic operation of the whole trust, the four hour target is effectively restricted to the ED.

    It is interesting that the CQIs relating to the performance of physicians have not been mentioned (time to treatment and consultant sign off).

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  • "the four hour target is restricted to the ED"

    On which planet?

    I do agree that these new indicators are a better measure of quality, however
    The only thing difficult about implementing the new KPIs is not having enough properly trained or adequately experienced nor numbers of staff to do a job which would meet the indicators.

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