The data vacuum in emergency and urgent care

Abstract

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.

Streaming primary urgent care: a prospective approach

“…Increasing demand for urgent care services continues to challenge western health-care provision (Lega and Mengoni, 2008; Scott et al ., 2009; Hughes et al ., 2011). In the United Kingdom, it is commonly assumed that up to 60% of patients attending emergency departments (EDs) are non-urgent (Audit Commission, 2001; Ya'ish et al ., 2007); more recent figures using a standardised definition indicate that between 10% and 30% of cases could be classified as primary care (Carson et al ., 2010).…”

“…Currently, there is a paucity of evidence available to support service re-configurations and re-design (Fisher et al ., 2010). In order to encourage service re-design, commissions are moving from block contracts to payment by results; however, indicators to measure results from urgent care are under-developed and are more likely to measure activity than results and this can give rise to perverse incentives (Carson et al ., 2010; Hughes et al ., 2011). More recently, the 4-h waiting time standard for EDs has been replaced with a range of clinical quality indicators (Department of Health, 2010a) and with a more decentralised approach to the provision of primary and urgent care facilities introduced, enabling local commissioners to design services for local populations.…”