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Updated framework on quality and safety in emergency medicine
  1. Kim Hansen1,2,
  2. Adrian Boyle3,
  3. Brian Holroyd4,5,
  4. Georgina Phillips6,7,
  5. Jonathan Benger8,
  6. Lucas B Chartier9,10,
  7. Fiona Lecky11,12,
  8. Samuel Vaillancourt13,
  9. Peter Cameron7,14,
  10. Grzegorz Waligora15,
  11. Lisa Kurland16,
  12. Melinda Truesdale17,18
  13. on behalf of the IFEM Quality and Safety Special Interest Group
    1. 1 Emergency Department, Prince Charles Hospital, Chermside, Queensland, Australia
    2. 2 Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
    3. 3 Emergency Department, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
    4. 4 Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
    5. 5 Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
    6. 6 Emergency Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
    7. 7 Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
    8. 8 Academic Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
    9. 9 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    10. 10 Emergency Department, University Health Network, Toronto, Ontario, Canada
    11. 11 Health Services Research, University of Sheffield, Sheffield, UK
    12. 12 Emergency Department /TARN, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
    13. 13 Emergency Department, St Michael's Hospital, Toronto, Ontario, Canada
    14. 14 Emergency Department, Alfred Hospital, Melbourne, Victoria, Australia
    15. 15 Emergency Department, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland
    16. 16 Medical Sciences, Orebro Universitet, Orebro, Sweden
    17. 17 Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
    18. 18 Emergency Department, Royal Women's Hospital, Parkville, Victoria, Australia
    1. Correspondence to Dr Kim Hansen, Emergency Department, Prince Charles Hospital, Chermside, QL 4032, Australia; hansenke{at}


    Objectives Quality and safety of emergency care is critical. Patients rely on emergency medicine (EM) for accessible, timely and high-quality care in addition to providing a ‘safety-net’ function. Demand is increasing, creating resource challenges in all settings. Where EM is well established, this is recognised through the implementation of quality standards and staff training for patient safety. In settings where EM is developing, immense system and patient pressures exist, thereby necessitating the availability of tiered standards appropriate to the local context.

    Methods The original quality framework arose from expert consensus at the International Federation of Emergency Medicine (IFEM) Symposium for Quality and Safety in Emergency Care (UK, 2011). The IFEM Quality and Safety Special Interest Group members have subsequently refined it to achieve a consensus in 2018.

    Results Patients should expect EDs to provide effective acute care. To do this, trained emergency personnel should make patient-centred, timely and expert decisions to provide care, supported by systems, processes, diagnostics, appropriate equipment and facilities. Enablers to high-quality care include appropriate staff, access to care (including financial), coordinated emergency care through the whole patient journey and monitoring of outcomes. Crowding directly impacts on patient quality of care, morbidity and mortality. Quality indicators should be pragmatic, measurable and prioritised as components of an improvement strategy which should be developed, tailored and implemented in each setting.

    Conclusion EDs globally have a remit to deliver the best care possible. IFEM has defined and updated an international consensus framework for quality and safety.

    • quality improvement
    • safety
    • risk management
    • emergency care systems
    • emergency department

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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    • Handling editor Ellen Weber

    • Twitter @hansendisease

    • Collaborators IFEM Quality and Safety Special Interest Group: Katie Walker.

    • Contributors KH: initiated the concept, organised the group, developed the first draft, contributed to writing and review of manuscript, developed the tables and images, prepared manuscript for submission, led the revision. MT: assisted with planning of the document, developed the first draft with KH, contributed to writing and performed thorough and multiple reviews of the manuscript, assisted with preparation of tables, prepared manuscript for submission. AB: contributed to writing and review of manuscript. BH: contributed to writing and review of manuscript. GP: contributed to writing and review of manuscript. JB: contributed to writing and review of manuscript, author of the first edition. LBC: contributed to writing and review of manuscript. FL: contributed to writing and review of manuscript, author of the first edition. SV: contributed to writing and review of manuscript. PC: contributed to writing and review of manuscript, author of the first edition. GW: contributed to writing and review of manuscript. LK: contributed to writing and review of manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Professor Jonathan Benger is an Emergency Physician in the UK and is the acting Chief Medical Officer for NHS Digital, the national information and technology partner to the health and care system in England. Dr Kim Hansen is Chair of the Board of the Emergency Medicine Foundation in Australia.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study.

    • Author note This paper is derived from the 2018 Update Quality Framework document available from the International Federation for Emergency Medicine resources library at

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