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Meaningful metrics are crucial to improving patient care and driving change

24 November 2022

Responding to news that ministers plan to ditch the metrics for Emergency Care performance outlined in the Clinical Review of Standards, President of the Royal College of Emergency Medicine, Dr Adrian Boyle said:

“Emergency Medicine access standards are important for quality, accountability and driving improvement. For many years these standards successfully improved patient care and reduced waiting times. But recently we have been in a performance vacuum where standards have simply documented the emergency care system’s failure to function as it should.

“The Clinical Review of Standards began as a means to transform our emergency care metrics. The College engaged in good faith with a vision to implementing trustworthy metrics that better represent the patient experience in Emergency Departments and improve the quality of care. We recognised that was justified as the four-hour standard is a blunt tool and has unintended consequences. However, the four-hour standard is better than no effective standard, which is where we are now, so this recommitment to it is welcome.

“In October, we recorded the lowest four-hour performance on record at 54.8% in type 1 Emergency Departments. With no meaningful metric to hold systems accountable or measure quality, we have no means to drive any improvement. Bluntly people will stay longer in emergency departments. Improving performance against the four hour access standard will increase capacity in emergency departments and help improve ambulance hand over times.

“Data and metrics provide transparency to our patients around the quality of care we are providing and incentivise staff and Trusts to improve processes and patient care. The four-hour standard can still drive change and improvement, if there is a system wide recommitment to it and refocus on it. Alternatively, if the Department of Health and Social Care and NHS England are, in time, willing to revisit the Clinical Review of Standards, we would welcome that too. However, along with this welcome refocus on the four-hour standard, we must have transparency of data that does not hide patient experiences and dangerously long stays. We must see the routine, monthly publication of 12-hour data measured from time of arrival in Emergency Departments – this will be a catalyst of transformation and change that will drive improvement. Any other 12-hour data is disingenuous about the true nature of patient waits.”

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