Table 1

Suggested indicators for EDs, grouped by the domains of structure, process and outcome to address the six Institute of Medicine domains of ‘high quality care’

Safe Clinicians with the right skill mix
Adequate and appropriate assessment spaces
Adequate security
Reporting system for safety concerns (without fear of reprisal)
Ability to share and learn from adverse incidents
Administration acts on staff concerns
Analysis of incident reports (there should be many non-serious incidents and a few serious incidents)
Incidence of hospital-acquired infection, medication errors, violent incidents
Effective Adequate assessment spaces
Sufficient equipment
Adequate and effective monitoring
Disaster/major incident plan
Care standards or evidence-based guidelines for common and important presentations available
Quality improvement activity being conducted
Audit performance against international, national or local standards for common presentations, such as sepsis or multiple injuries
Morbidity/Mortality (general or specified conditions)29
Hospitalised Standard Mortality Ratio 30
Diagnostic and procedural errors
Patient-centred Structural environment allows for privacy and dignity
Dedicated areas for vulnerable groups (eg, children, mentally ill, elderly)
Patient complaint system (with follow-up actions)
Left without being seen rate
Patient experience
Patients’ ability to participate in own care
Collection and use of patient-reported outcomes
Time to analgesia audit
Timely Ambulance notification system
Adequate clinicians to initially assess a patient promptly
Patients seen initially by a clinician trained in triage
Time to consultation by doctor
Time to be seen by decision maker
Patients needing admission are moved swiftly out of the ED
Total length of stay in the ED (from arrival to departure)
Percentage of patients who leave the ED without being seen
Efficient Emergency clinicians available who can assess and provide initial treatment for all emergency presentations, regardless of age or pathologyPatients investigated and treated according to evidence-based guidelines
Appropriate use of investigations
Appropriate and timely support from other specialities
Number of admissions from the ED
Avoidable patient re-presentations to the ED
Good communication with other healthcare providers
Equitable ED available to all patients who need it, 24/7, regardless of age, disease or financesPatients seen in order of clinical priority Comparable access and clinical outcomes despite:
  • gender

  • race

  • religion

  • other minorities

  • ability to pay