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J R Soc Med. 2001; 94(Suppl 39): 31–37.
PMCID: PMC1310594

Evaluating emergency services activity at the health district level.


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. There are about eight main sources of current indicators. Unfortunately the availability, timeliness, and quality of these indicators is variable. A new development is situation reporting on emergency pressures ('Sitreps'). This provides a fortnightly and sometimes daily picture of current emergency activity as measured by key indicators such as the number of delayed discharges from hospital, the number of cancelled operations, and the number of medical inpatients outlying on other wards. 'Sitreps' was particularly helpful in handling emergency activity at the new millennium period. 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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