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Quality Improvement

Quality Improvement

Welcome to the Royal College of Emergency Medicine's Quality Improvement and Clinical Audit pages. Read information about delivering quality care and quality improvement, alongside the Royal College of Emergency Medicine's Clinical Audit resources and reports.

Quality Improvement

This page is managed by the Quality Assurance and Audit committee, which is part of the Quality in Emergency Care Committee: further information about these committees can be found on the RCEM ‘Structure and Governance’ Committees pages. Available at:

RCEM ‘Structure and Governance’ Committees pages

The QECC has produced a series of strategy documents, explaining the role of RCEM, and these committees, in improving patient care. These are:

  • Emergency Department Standards (principally QI&A Committee)
  • Patient experience in Emergency Departments (principally Best Practice Committee)
  • Safety in Emergency Departments (principally Safer Care Committee)

If you would like to comment on the content of these pages, or become involved in these committees please contact the chairs of the committees.

Should you have any questions please email audit@rcem.ac.uk or telephone 020 7404 1999.

Current RCEM QIPs

2021/2022 QIP Programmes.

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

Registration costs are available here.

2021/2022 Audit and QIP Programme

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

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

Consultant Sign off – Data collection (4 Apr 2022 – 3 Oct 2022)

More information about this QIP will be made available at a date closer to the start of the study period.

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 the College administrator of any changes to your contact details (see details below).

Support

Should you have any questions please email audit@rcem.ac.uk or telephone 020 7404 1999.

External Audits

Urgent and Emergency Care Clinical Audit Toolkit

A learning tool to support the quality of urgent and emergency care services for patients was launched on 30th March 2011 by the Royal College of General Practitioners. Go to the Audit Guidance page for more information and to download the toolkit.

National Care of the Dying Audit for Hospitals in England

For the first time, a survey of bereaved relatives’ views has been performed alongside organisational and clinical audit elements, as part of a national audit of care of the dying. The audit was delivered by the Royal College of Physicians (RCP) in collaboration with the Marie Curie Palliative Care Institute Liverpool. The full national audit report and an executive summary can be downloaded from the RCP website.

NCAPOP and Audit Resources

The Healthcare Quality Improvement Partnership (HQIP) manages and develops the National Clinical Audit and Patient Outcomes Programme (NCAPOP). In addition HQIP is developing guidance and resources to assist local clinical audit programmes. See more here.

Previous Audits

+ 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 QIP

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 QIP 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 rcem.l2s2.com. 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 https://rcem.l2s2.com

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 audit@rcem.ac.uk or by telephoning 020 7400 6108.

+ 2003-2008: 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:

Audit Guidance

Clinical audit is a process of systematically evaluating care against agreed standards. Audit should be followed by changes designed to improve conformity with the standards and then by re-evaluation to demonstrate such improvement. This is known as the audit cycle. Since 2003 the Royal College of Emergency Medicine (formerly CEM) has worked with the Care Quality Commission (formerly the Healthcare Commission) to conduct audits to assist Emergency Departments in improving their quality of care.

Audit Guidance

Urgent and Emergency Care Clinical Audit Toolkit – 30th March 2011

A learning tool to support the quality of urgent and emergency care services for patients has being launched by the Royal College of General Practitioners.

The Urgent and Emergency Care Clinical Audit Toolkit, which has been extensively piloted, will help provide a seamless approach to promote quality care across a range of NHS services. The toolkit is for all providers of urgent and emergency care, including clinicians and non-clinicians, out of hours doctors, emergency departments, walk-in centres, GP medical practices, pre-hospital emergency care doctors, NHS Pathways, NHS Direct, the Ambulance Service, and urgent care centres.

RCEM Audit Programme

  • Download the aims of the College’s audit programme here.

Advice for EDs regarding the prioritisation of multiple audit demands

The College has set out recommendations about how requests to participate in clinical audit are prioritised. Download the document here.

Clinical Standards

The audits are measured against standards produced by the College Quality in Emergency Care Committee.

FAQs

See the data collection tools for answers to frequently asked questions about completing the audits. If you have any questions not answered by the guidance please contact the audit administrator by e-mail ataudit@rcem.ac.uk, or by phone at 020 7400 6108.

Audit Guide

Emergency Departments conduct their own audits in addition to those conducted by the College. Departments may use previous RCEM audit tools to conduct local audits.

The Healthcare Quality Improvement Partnership (HQIP), has developed tools and guidance to assist local clinical audit teams in a variety of ways. Please visit their website for more information here.

Information Governance

The audit data collection tools are designed so that no patient identifiable data can be submitted.

Inclusion Health Clinical Audit

Homeless patients need better information provision to improve care. Find new reports looking at A&E care below. The first steps to improve care for homeless patients in A&E are being taken by the Royal College of Emergency Medicine (RCEM), the Royal College of Physicians (RCP), and the Faculty for Homeless and Inclusion Health (FHIH).

Reports and news story

Two new reports from RCEM have found that, whilst care for the homeless in A&E is good overall, there are many ways in which care could be improved. For example, care could be improved by providing more written information during an A&E visit, and signposting homeless people for help and support in the community.

“Homeless people represent some of the most vulnerable individuals in our society. It is surely a marker of a civilised society that care and concern for these people is reflected in the provision of appropriate healthcare services.”
– Dr Cliff Mann

Pilot audit documents

Timeline

  • Audit development: June – Oct 2015
  • Pilot sites registration: 15-30 Oct 2015
  • Pilot data collection: 23 Nov – 6 Dec 2015
  • Pilot data entry: 23 Nov – 8 Dec 2015
  • Pilot report published: 22 Dec 2015
  • Development of national clinical audit: No national clinical audit is currently planned.

Further information

For press and media enquiries, contact gordon.miles@rcem.ac.uk. To find out more information about the pilot audit, contact sam.mcintyre@rcem.ac.uk

Frequently Asked Questions

Q) How do I submit or edit data?

All data should be submitted online at audit.rcem.ac.uk. You will need to log in to submit data, all registered users have been set up with accounts. Department Admin users will be able to set up additional user accounts for staff in their organisation.

Q) What are the audit questions and standards?

The audit questions and standards, as well as the methodology, evidence base and analysis plan are accessible in the audit information packs.

Q) How do I use the data entry system?

The system is quite intuitive to use, but if you need any help please have a look at the user guide. This explains how to use the system to enter data, check your data, and create new user accounts.

Q) What do the dashboard charts mean?

The charts are called Statistical Process Control (SPC) charts. They plot your data each week against the national data (or your country data if you prefer), so you can see variation and improvement over time. Making Data Count is a really good guide developed by NHS Improvement to explain all about SPC charts.

Q) I need RCEM’s address to obtain a purchase order number.

Royal College of Emergency Medicine, 7-9 Bream’s Buildings, London, EC4A 1DT. Please contact finance@rcem.ac.uk for bank details.

Q) How do I work out our expected number of cases?

This means the number of eligible patients seen by your ED over the data collection period (1 January to 31 December), not the data submission period (1 August to 31 January). You can estimate this by running a query of the number of cases seen for the same period last year, or cases seen over the past month x12.

Q) Can all wards take part?

No, these audits are specific to type 1 Emergency Departments.

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