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Emergency departments in the UK have seen a marked increase in patient activity over the last few years. Until recently, this activity was paid for by block contracts between commissioners and providers. The management of this activity has now fallen under the ‘Payment by Results’ (PbR) system. In the past, the data collection system for this activity has been inaccurate and consequently payment has not followed the patient care and has lead to perverse incentives. This paper describes the current situation with respect to PbR, assesses the problems that currently exist and describes an initiative by the College of Emergency Medicine to improve data collection and accuracy to inform commissioners and clinicians of the clinical activity that is occurring within emergency departments.

Appropriate education and implementation of departmental guidelines can result in more effective and efficient use of resources when dealing with nasal fractures in accident and emergency.

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