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’
| Domain | Structure | Process | Outcome |
| 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 pathology | Patients 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 finances | Patients seen in order of clinical priority |
Comparable access and clinical outcomes despite:
|