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Quality Improvement

Quality Improvement

Information about delivering quality care and quality improvement, alongside the Royal College of Emergency Medicine's Clinical Audit resources and reports.

Quality Improvement

We have a number of committees and working groups which look after quality in emergency departments, with the aim of improving standards and patient care.

A key part of this work is our Quality Improvement Programme (QIPs), which you can read more about below, along with resources and guidance.

Please read RCEMs Quality Improvement Plan below for details on our programmes annual focus and objectives.

RCEM Healthcare Quality Improvement Plan 2025

 

You can also see more about our clinical guidance in our Clinical Guidance section.

Quality Improvement Programmes 2023/24

Data Entry Extension for 2023/24 QIPs

We are pleased to announce an extension for data entry to the 2023/24 Quality Improvement Projects (QIPs), covering Time Critical Medications, Mental Health: Self Harm, and Care of Older People. The new deadline is Midnight on the 23rd of October 2024. Any data entered after this date will not be included in reporting.

This extension is provided specifically to complete the entry of data collected during the designated collection period, which ran from 4th October 2023 to 3rd October 2024. Please ensure that only patients who arrived at an ED during this period are submitted to the portal; patients who arrived before or after this period will not be included in reporting.

If you have any questions, please do not hesitate to get in touch with the Quality team at RCEMQIP@rcem.ac.uk.

We run three QIPs at a time and our current QIPs are listed below, and previous QIPs can also be found on this page.

Please note, the National Data Opt Out Policy began on 31 March 2022 and as data inputted into QIPs is anonymous, it does not apply to RCEM – you can however read our statement on it here. National Data Opt Out Policy statement.

Mental Health (Self-Harm) (Year 2)

Care of Older People (Year 2)

Time Critical Medications (Year 1)

QIP Registration

Registration is now open to all Type 1 UK Emergency Departments. Please complete and submit the Clinical Audit Registration Form via the button below to register your ED.

 

2025 QIP Registration Form QIP Terms and Conditions QIP Data entry portal userguide

 

Contact and Support

RCEM QIP Contacts

It is important for the College to maintain contact details for consultants and administrators responsible for audit/QIPs in their Departments in order to keep them informed of RCEM QIPs developments. Please notify rcemqip@rcem.ac.uk of any changes to your contact details (see details below).

Previous Data Entry Portal

As above, RCEM has a new data entry for QIPs where all data entry for the 2023-24 cycle and future cycles will take place.
Please see the Data Entry Portal.
In the future, RCEM will also add local reports and data entry access for previous QIPs for local analysis and projects. Please note, local reports and access to these previous QIPs will only be provided to those who have previously participated in and/or have paid for access.

In the interim the previous site remains open for purely local access for local QI projects and previous reports.
Any data submitted for the 2023/24 RCEM QIPs onto the previous website will not be counted.

If your team needs access to the previous site for one of these purposes, please contact our team at rcemqip@rcem.ac.uk.

Support

Please see the Data Entry Portal user guide below:
RCEM QIP Portal User Guide 2023/24

Should you have any questions about the RCEM QIPs, please email rcemqip@rcem.ac.uk or telephone 020 7404 1999.

Recent Webinars

RCEM TCM QIP April Webinar – How can you identify patients on TCM for this QiP?

Frequently Asked Questions

+ What is changing?

In order for RCEM to continue to develop and enhance the QIP programmes took the decision to commission a bespoke QI platform to suit our specific needs. The new portal has been created especially for RCEM QIPs, it has been built by our own expert IT team and the result is a new portal which will provide better user experience and functionality. The design builds on all our experience as world-leading EM QIP providers and responds to feedback provided by our project teams.

+ Why have you made this change?

We are constantly seeking to improve the service we provide. As well as an enhanced user experience, the new bespoke portal also provides the following:

  • data visualization, and streamlined reporting, allowing users to make more informed decisions with ease.
  • An online resource hub providing resources to support sites with the QIPs process, and Quality Improvement.
  • A streamlined process allowing direct access to the RCEM QIP team and the team which designed the portal

In addition, RCEM’s dedicated QIP team will support project teams by providing:

  • Quarterly Check-ins to give hospital sites on-going support, timely feedback, and the opportunity to discuss any challenges. This will ensure continuous improvement and alignment with quality standards throughout the project.
  • A dedicated QIP Newsletter: The quarterly newsletter for QIP site users will deliver valuable updates, best practice insights, and key resources, helping your team stay informed and engaged with the latest program developments and improvements.
+ Who can take part in QIPs?

Our QIPs are for Hospitals with Type 1 Emergency departments. Each Emergency Department needs to complete its own registration form and indicate the QIPs it will be participating in.

+ What are the QIPs and why should we sign up?

The RCEM (Royal College of Emergency Medicine) QIPs (Quality Improvement Programmes) for Type 1 Emergency Departments are designed to help hospitals enhance the quality of care in emergency settings through a quality improvement framework. These projects provide a structured approach to identifying areas for improvement and implementing changes that can lead to better patient outcomes. We have three QIP topics running every year. The QIPS are featured in the HQIP directory found here. The QIP questions and standards, as well as the methodology, evidence base and analysis plan are accessible in the information packs on our website.

For more information on the specifics of each QIP, please see our website. Or email the team at RCEMQIPS@rcem.ac.uk and we will get back to you. Additionally, you can phone us 020 7404 1999 and select option 2

+ What does a site get when taking part in the QIPs?
  • Annual local and national report
  • Quarterly Check-ins
  • QI Portal access with dashboard
  • Newsletter Updates
  • Resource Hub
  • Supportive information on how to reduce data burden
+ What is the price of the 2025 QIPs?
QIPs Price From November 2024 (Per QIP): 1 2 3
Fee, exclusive of VAT (Net) £1,500 £2,500 £3,000
+ What QIPs will be running in 2025?
  • Mental Health (Self Harm) – Year 3
  • Care of Older People – Year 3
  • Time Critical Medications – Year 2.
+ What is the registration, data inclusion period and data entry period?

Registration for the 2025 QIPs will open on 28 October 2024

The data inclusion period is 1st January – 31st December 2025. This specifies the time frame that the patient cases must fall within to be considered in the QIPs.

The portal will open on 14th January 2025 for cases to be entered. The data entry period for the QIPs is 14thth January 2025 to 14thth January 2026.

+ Can I sign up for more than one QIP?

Yes. It is also more cost effective to sign up to more than one QIP at a time, you can select the QIPs you want to enrol in on the registration form.

+ When does registration open?

Registration for the 2025 QIPs will open on 28 October 2024.  You will be able to register by visiting this page of our website

+ Once I have registered will I get access to the portal straight away?

No. Our team need to do some preparation work to set you up on this system. This is why we leave a short period of time between registration and the portal opening. You will be given details of how to access the portal and all the training you and your team will need once registration has been completed.

+ When will the portal open:

The QI Portal for data entry will open on 14th January 2025.

+ How do I register for the QI Portal?

Complete the registration fund on our RCEM QIPs homepage: Quality Improvement | RCEM

+ If I have any questions about registration, or about the QIPs, who can I contact?

You can email the team via RCEMQIPS@rcem.ac.uk and we will get back to you. Additionally, you can phone us 020 7404 1999 and select option 2

+ How can I access the new portal?

The new portal will be accessible from 14th January 2025. The access link will be provided via email to registered sites and on the QIPs homepage

+ Are the RCEM QIPs in the HQIP Directory?

Yes. The HQIP Directory is a tool/resource designed to assist healthcare service providers in planning and reporting on their quality improvement and audit activity each year .For more information please see the HQIP website.

+ I need RCEM's address to obtain a purchase order number.

Royal College of Emergency Medicine, Octavia House, 54 Ayres Street, London, SE1 1EU.
Please contact finance@rcem.ac.uk for bank details.

+ Where can I find further information on the QIPs?

All information will be posted on the QIPs website and emailed to the three main contacts sites provided upon registration. Please contact RCEMQIPS@rcem.ac.uk  if you wish to be added to our mailing list.

Previous Audits

+ 2022/23: Infection Prevention, Mental Health (Self-Harm) and Care of Older People

2022/2023 Audit and Quality Improvement Programme

Infection Prevention Year 3
Year 3 data collection 3 October 2022 – 3 October 2023

Mental Health (Self-Harm) Year 1
Year 1 data collection 3 October 2022 – 3 October 2023

Care of Older People Year 1 –
Year 1 data Collection 5 May 2023 – 3 October 2023

National and Local Reports

Reports for the 2022-23 QIPs are due for publication in early 2024.

+ 2021/22: Pain in Children, Infection Prevention and control, Consultant Sign Off’

2021/2022 Audit and Quality Improvement Programme

Pain in Children – Data collection (4 October 2021 – 3 October 2022)

Infection Prevention and Control – Data collection (4 October 2021 – 3 October 2022)

Cycle Consultant Sign off – Data collection (01 April 2022 – 03 October 2022)

+ 2020/21 Fractured Neck of Femur, Infection Prevention & Control, Pain in Children, National Ethnicity Report

2020/21 Fractured Neck of Femur, Infection Prevention & Control, Pain in Children, National Ethnicity Report

+ 2019/20: Mental Health (self harm), Assessing for Cognitive Impairment in Older People, Care of Children in the ED.

2019/20 RCEM national clinical audit and Quality Improvement Programme

Registration has now closed after being open to all Type 1 UK Emergency Departments.

Mental Health (self harm)

Assessing for Cognitive Impairment in Older People

Care of Children in the ED

+ 2018/19: Feverish child, Vital signs in adults, VTE risk in lower limb immobilisation

2018/2019 Audit and Quality Improvement Programme

Registered Emergency Departments (ED) are able to continue using the system for local data entry and quality improvement, and will be able to see this updated in their online dashboards.

Registration was open to all Type 1 UK Emergency Departments. Looking for information for your Quality Accounts? Log on to the portal to find the number of cases submitted.

Feverish Child

Vital Signs in Adults

VTE Risk in Lower Limb Immobilisation

+ 2017/18: Fractured neck of femur, Procedural sedation, Pain in children

2017/18 RCEM national clinical audits

Fractured Neck of Femur

*Note: These documents, initially published May 2018, were republished on 10 October to correct a data sampling error. See the announcement for full details of the changes.

Procedural Sedation

*Note: These documents, initially published May 2018, were republished on 10 October to correct a data sampling error. See the announcement for full details of the changes.

Pain in Children (moderate and severe pain)

* Note: These documents, initially published May 2018, were republished on 10 October to correct a data sampling error. See the announcement for full details of the changes.

+ 2016/17: Asthma, Consultant sign-off, Severe sepsis and septic shock

Asthma

Consultant sign-off

Severe sepsis and septic shock

+ 2015/16: Vital signs in children, Procedural sedation in adults, VTE risk in lower limb immobilisation in plaster cast, Inclusion Health (homelessness) pilot

Vital signs in children

Procedural sedation in adults

VTE risk in lower limb immobilisation in plaster cast

Each of the three audits are on the Quality Accounts 2015/16 list.

2015/16 RCEM Inclusion Health (homelessness) national clinical audit pilot

Find out more about the Inclusion health clinical audit piloted in December 2015. This audit looked at the organisation of EDs and the standard of care provided to homeless patients.

+ 2014/15: Initial management of the fitting child, Mental health in the ED, Assessing for cognitive impairment in older people

2014/15 RCEM national clinical audits

Important notice: The audit website address has changed. Previous audit reports and data files can be accessed at audit.rcem.ac.uk. The national and site-specific reports were published on 29 May 2015. The national reports can be downloaded below. Site-specific reports can be downloaded by registered users by logging into audit.rcem.ac.uk

Initial management of the fitting child

Mental health in the ED

Assessing for cognitive impairment in older people

Data collection system updates for 2014/15

A number of features have been improved for the 2014/15 audits. A summary of the changes can be found on the audit site bulletin board. Full details about how to use the system can be found in the user manual. Thank you to everyone who sent feedback about the system, which was of great help in making the improvements.

+ 2013/14: Severe sepsis & septic shock, Paracetamol overdose, Asthma in children

National report publications:

To download the individual report for your ED please go to the RCEM audit website (registered users only).

+ 2012/13: Consultant sign off, Feverish children, Fractured neck of femur, Renal colic

2013 Consultant sign-off

Participants were sent a report comparing their findings with the national results and previous findings on 24 July 2013.

2012-13 RCEM Audits: feverish children, #NOF and renal colic

A huge thank you to all of the Emergency Departments who submitted audit data for the 2012-13 audits. Reports have been sent by e-mail to each participating ED, comparing individual ED findings with the national results and RCEM standards (reports sent by e-mail on 6th February 2012).

In line with accepted best practice, and the expectations of our patients and the wider public, all audit data collected by the Royal College of Emergency Medicine from August 2012 are being shared with the Care Quality Commission (CQC), and placed in the public domain. It is important to note that clinical audit is an indicator of the quality of care provided and not an absolute measure; audit data should be interpreted alongside other indicators of care within the local context, and taking account of factors specific to individual Emergency Departments (EDs). Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. All EDs should seek to use audit data to help identify areas for improvement and seek to implement change to further improve, regardless of performance in relation to other EDs. Further information regarding the purpose and conduct of the College’s clinical audit programme can be found below.

The results from all participating EDs for the 2012 RCEM audits of feverish children, fractured neck of femur and renal colic are now available here. Details of the audit methodology and criteria can be found in the data collection tools which are available to download at the bottom of this page.

+ 2011/12: Pain in children, Severe sepsis & septic shock

2011-12 RCEM audits: pain in children and severe sepsis & septic shock

A huge thank you to all of the Emergency Departments who submitted audit data for the 2011-12 audits. Reports have been sent by e-mail to each participating ED, comparing individual ED findings with the national results and RCEM standards (reports sent by e-mail on 18th May 2012).

+ 2010/11: Consultant sign off, Feverish children, Renal colic and Vital signs in majors

Consultant Sign-Off

In December 2010 the Royal College of Emergency Medicine published a standard for ‘Consultant Sign-Off’ in UK and ROI Emergency Departments. This included an undertaking to audit and review the standard during 2011, and the College has therefore conducted a national audit of the standard in September 2011.

The purpose of the audit was to identify current levels of compliance with the College standard and the impact of this standard on current practice, in order to inform subsequent review.

Reports were sent to each participating ED on 22 December 2011.

The College and the Quality in Emergency Care Committee would like to thank all ED staff for their continued support of the national RCEM audit programme.

Feverish children, renal colic and vital signs in majors

We would like to thank all of the Emergency Departments who submitted audit data for the 2010-11 round. A record number of EDs participated. Reports have been sent by e-mail to each participating ED, comparing individual ED findings with the national results and RCEM standards (28 April 2011).

+ 2009/10: Pain in children, Fractured neck of femur, Severe and moderate asthma

We would like to thank all of the Emergency Departments who have submitted audit data for the 2009-10 round.

Reports have been sent by e-mail to each participating ED, comparing individual ED findings with the national results and RCEM standards (5th Nov 2011).

An executive summary of the national findings for the three audits can be downloaded here:

+ 2008/09: Pain in children, Fractured neck of femur, Paracetamol overdose

The national findings for the audits undertaken in 2008/2009 are available below:

The reports have been prepared by the Care Quality Commission and compare your Emergency Department with other departments nationally that completed audit returns.

We are sure that all departments will strive to make continuous improvements but would ask all those that fall in the lower performance quartile to address improvement issues as a matter of urgency in order to ensure high quality is delivered to all who use your service.

We would also encourage you to share these reports with your trust board.

Information from these reports will feed in to the Care Quality Commission’s assessment of NHS Trusts.

Should you think that any of the information contained in these reports misrepresent the results for your department, please contact RCEM by emailing quality@rcem.ac.uk or by telephoning 020 7400 6108.

+ 2003 to 2008: Pain in children, Fractured neck of femur, Paracetamol overdose

Summary of key findings 2003-2008

The College has produced a report summarising the results from three of the national audits (pain in children, fractured neck of femur and paracetamol overdose) which have been repeated in Emergency Departments (EDs) between 2003 and 2008.

+ Previous audit tools (excel downloadable versions)

Emergency Departments are welcome to use previous audit tools to assist them in conducting their own audits. Click on the links below:

Quality Improvement Resources

This page collates some of the most useful quality improvement resources for ED staff, including trainees and supervisors preparing for exams.

What is Quality Improvement?

“The conception of improvement finally reached as a result of the review was to define improvement as better patient experience and outcomes achieved through changing provider behaviour and organisation through using a systematic change method and strategies.” (Dr John Øvretveit, Does Improving Quality Save Money? Sept 2009).

What is Quality Care?

The Institute of Medicine (IoM) defines quality care as: safe, effective, patient-centered, timely, efficient and equitable. Read more about these six domains of quality in Crossing the Quality Chasm (IoM, March 2001).

Featured resources for quality improvement in the ED


Resources

 


Resources for supervisors

Whilst a good knowledge of QI is useful for all ED staff, below are specific resources you will need to supervise trainees in choosing projects and completing a high quality QIP.

Trainees should be encouraged to practice small QI projects during foundation and core training, either as collaborators or project leads. It is generally accepted that trainees do better if they choose their own subject areas as this helps maintain interest. Regular review of a trainee’s project is important.


Useful QI resources

Introduction to QI principles and methods

Data and analysis

Courses, further learning and local initiatives

Journals


Websites for QI organisations



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