Journal of the Royal Society of Medicine
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The primary objectives of the emergency services are to minimize early mortality and complications, although longer-term morbidity, quality of life and late mortality may also be influenced by early actions. Evaluation of the emergency services and demonstration of quality need to reflect these objectives by appropriate choice of outcome measures. ⋯ The review also discusses capacity, a necessary requirement for a quality service, and operations research/queuing theory to facilitate management of capacity/resources to meet fluctuating demands. The NHS should be able to plan for seasonal needs.
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We do not have good information on the incidence and prevalence of emergency conditions nor is there good research evidence on the best ways of meeting these. There are, however, some indicators for evaluating emergency services activities and we have a good framework from Donabedian for evaluation, and the important dimensions of quality specified by Maxwell. The range of emergency services covers primary care, community crisis care, ambulance services, hospital services (accident and emergency [A&E] department, inpatient, critical care), laboratory (blood supplies, tests), social services, and public health. ⋯ We need to specify a comprehensive, valid and easily collectable data set for assessing the quality of emergency services. This would include better ways of forecasting for early warning purposes. This could be done by monitoring the incidence of absenteeism, the sale of over-the-counter drugs, and the number of deaths in nursing homes.
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Anaesthetists provide services throughout acute hospitals in areas such as the delivery floor and the intensive therapy unit as well as working in their traditional role in the operating theatre. Consensus standards of the number of staff needed to provide a satisfactory level of acute anaesthetic services, their qualifications and experience and the resources they require have been produced by a number of organizations. It is probable that many small and medium-sized district general hospitals will be unable to meet these standards without changes to traditional UK staffing structures.
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The interface between primary and secondary care in the UK has been affected by a number of recent changes, particularly in provision of out-of-hours care and advice. This paper reviews some current measures of healthcare quality and argues that many do not adequately measure contributions in primary care. To overcome these deficiencies the Royal College of General Practitioners (RCGP) has published guidelines on issues of quality in primary care.
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There are numerous standards currently available that relate to accident and emergency medicine. Some of these relate to organizational structure; others are clinical and relate either to the process of care or to outcomes. Few, if any, deal explicitly with the dimensions of quality mentioned in recent white papers about the NHS. It is suggested, to maximize the effect standards have on care, that they should be developed for existing technologies not just for novel ones, rigorously developed and effectively disseminated and implemented, formally evaluated after their introduction and mutually compatible.