RCEM release position statement on metrics to supplement four-hour target

11 March 2019

The Royal College of Emergency Medicine (RCEM) supports the continued use of the four-hour access standard as a high-level metric to monitor emergency care system performance. 

 
However, the problems and care models in Emergency Departments have changed considerably over the last 10 years and it is the College’s role to responsibly decide what standards we think usefully inform assurance, improvement efforts and patient safety.
 
As such the Royal College of Emergency Medicine today issues the position statement ‘Improving Quality Indicators and System Metrics for Emergency Departments in England’.  
 
We have reviewed and discussed a variety of time-based metrics. These should be seen as supporting and refocusing the efforts to monitor system flow which we know is 'mission critical' to safety in Emergency Departments.
 
The College is still very clear that rather than scrapping the four-hour access standard, it should be supported by a series of complementary metrics that help understanding of the causes of long waits and crowding in Emergency Departments. 
 
The position statement sets out what the College believes are the best supplementary measures to the four-hour standard that will ensure safety and facilitate the best care possible for patients.
 
President of the Royal College of Emergency Medicine, Dr Taj Hassan said: “While we are dismayed by many of the myths being pedalled around the four-hour standard, we are keen to ensure that any changes are not imposed due to political will but are developed responsibly, collaboratively and are based upon clinical expert consensus in the best interests of patients.

“The measures set out in this document are what we believe are in the best interests of patients and will enhance and refine the four-hour standard as a powerful system measure of flow. These have been developed based on the expert opinion of clinicians working in emergency medicine and are supported by a range of colleagues from other specialties. We also note that the last multidisciplinary evidence-based review in Scotland by Sir Harry Burns in November 2017 clearly stated that the four-hour standard should be retained. 
 
“We note the Prime Minster made a commitment to involve clinicians in the development of new standards. While we have been disappointed to not have been involved from the outset of this process, and that there has been little clarity around who has been involved, we now look forward to providing our clinical expert advice to NHS England and NHS Improvement to assist them in their review.

“Only by collaborating and sharing expertise will we be able to develop a suite of additional standards that enhance clinical care and maintain a focus on safety. 

“Robust joint evaluation of any new measures will need to be developed to ensure that any potential change can prove more effective and safer than the existing arrangements before they are adopted.

“This will allow us then to better understand and find shared solutions to meet the needs of our patients and the staff who have to care for them in an intense healthcare environment. We are pleased to have agreed with NHS England that if we cannot find a better flow metric than the four-hour standard at the end of the evaluation then it should be retained.”