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Measurement and improvement of emergency department performance through inspection and rating: an observational study of emergency departments in acute hospitals in England
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  • Published on:
    Are Care Quality Commission inspections fostering a vicious cycle of (quality) improvement?
    • Jordan Webb, Emergency Physician Tamworth Rural Referral Hospital

    To the editor,
    I read with interest the recent article by Allen et al, “Measurement and improvement of emergency department performance through inspection and rating: an observational study of emergency departments in acute hospitals in England”1.
    National Health Service (NHS) performance indicators are cited throughout Care Quality Commission (CQC) reports when rating emergency departments4-8. Given use of these data as justification for achieving a specific rating, it is reasonable for the authors and the wider acute medicine and healthcare communities to assume a relationship exists between improved ratings and improved performance. Allen et al found no such relationship on any of the 6 emergency department NHS performance indicators prior to CQC inspection and on the subsequent rating score. This finding expands the void of evidence to support the suggestion of improved emergency department performance after inspection and published ratings2.
    Performance indicators such as those implemented by Allen et al and the CQC have evolved over the
    last 2 decades as we attempt to “cross the quality chasm”. Time and presentation-based data points
    such as time to assessment and treatment, time in department, unplanned re-presentations, left
    before being seen etc. are easily measurable since the advent on electronic health records and patient
    management systems. Their reflections in the tenets of the Institute of Medicine’s ideals of safety...

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    Conflict of Interest:
    None declared.