EMERGENCY MEDICINE - ACHS · Australasian Clinical Indicator Report . 2009–2016 . 18. th Edition...
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EMERGENCY MEDICINE VERSION 6 Retrospective data in full ACIR 2009 - 2016
Transcript of EMERGENCY MEDICINE - ACHS · Australasian Clinical Indicator Report . 2009–2016 . 18. th Edition...
EMERGENCYMEDICINE
VERSION 6Retrospective data in full
ACIR 2009 - 2016
Australasian Clinical Indicator Report 2009–2016
18th Edition
Emergency Medicine, version 6
Clinical Indicators
Acknowledgements:
The Australian Council on Healthcare
Standards
Health Services Research Group
University of Newcastle
Australasian Clinical Indicator Report 2009–2016 © ACHS. This work is copyright. Requests and inquiries concerning reproduction and rights should be addressed to [email protected]
Contents
Emergency Medicine, version 6 1
Waiting time ........................................................................................................................................ 1 1.1 ATS Category 1 - medically assessed and treated immediately (H) 1 1.2 ATS Category 2 - medically assessed and treated within 10 minutes (H) 3 1.3 ATS Category 3 - medically assessed and treated within 30 minutes (H) 5 1.4 ATS Category 4 - medically assessed and treated within 60 minutes (H) 7 1.5 ATS Category 5 - medically assessed and treated within 120 minutes (H) 9 1.6 Patients who left the ED after triage without being seen (L) 11
ST-segment elevated myocardial infarction (STEMI) management ............................................. 13 2.1 STEMI patients who receive thrombolytic therapy within 30 minutes (H) 13 2.2 Time to balloon opening within 90 minutes (H) 14 2.3 Time to balloon opening within 60 minutes (H) 15
Emergency department mental health presentations ................................................................... 16 3.1 Mental health patients admitted from the ED within 4 hours (H) 16 3.2 Mental health patients discharged from the ED within 4 hours (H) 17 3.3 Mental health patients who did not wait following clinical documentation (L) 19
Critical care....................................................................................................................................... 21 4.1 ED time within 4 hours for ICU admissions (H) 21 4.2 Rapid response system call within 4 hours of admission to the ward from the ED (L) 22
Sepsis management ........................................................................................................................ 23 5.1 Time of antibiotic administration for paediatric patients within 60 minutes (H) 23 5.2 Time of antibiotic administration for adult patients within 60 minutes (H) 24
Discharge communication .............................................................................................................. 25 6.1 Documented evidence of clinical management plan provided to an ongoing care provider (H) 25 6.2 Documented evidence of patient-centred discharge information and instructions provided to the patient or carer (H) 26
Pain management ............................................................................................................................ 27 7.1 Documented initial pain assessment at triage (H) 27 7.2 Analgesic therapy within 30 minutes for all patients with moderate or severe pain (H) 28 7.3 Documented pain reassessment within 30 minutes of analgesic therapy (H) 29
Unplanned re-attendance ................................................................................................................ 30 8.1 Patients who have an unplanned re-attendance to the ED within 48 hours of initial presentation and who require admission (L) 30
Characteristics of contributing HCOs ............................................................................................ 31
Summary of Results 35
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Emergency Medicine, version 6 Waiting time
1.1 ATS Category 1 - medically assessed and treated immediately (H)
Rationale
Timeliness of care related to the urgency of care is important for emergency department (ED) patients. Overcrowding is associated with increased patient waiting times, which can lead to poorer patient outcomes.
Numerator Number of patients allocated ATS Category 1 who are medically assessed and treated immediately after arrival time.
Denominator Number of patients attending the ED triaged to ATS Category 1.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2009 192 30,642 30,954 99.0 99.1 99.9 290 191 2010 183 31,435 31,598 99.5 99.5 100 150 83 2011 183 30,391 30,538 99.5 99.4 100 135 93 2012 169 26,102 26,340 99.1 99.3 99.9 223 183 2013 160 25,120 25,288 99.3 99.5 100 158 118 2014 129 24,371 24,447 99.7 99.7 100 67 51 2015 125 24,710 24,854 99.4 99.6 100 138 104 2016 124 28,746 28,857 99.6 99.6 100 100 74 # per 100 patients
In 2016, there were 206 records from 124 HCOs. The annual rate was 99.6 per 100 patients.
Trends
The fitted rate improved from 99.2 to 99.6, a change of 0.39 per 100 patients.
Trend plot of rates and centiles by year
Variation between strata
There were no significant stratum differences in 2015 and 2016.
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Emergency Medicine, version 6
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Variation between HCOs
There was relatively little variation between HCOs and so the potential gains were small in 2016.
Outliers
In 2016, there were six outlier records from four outlier HCOs whose combined excess was 74 fewer patients allocated ATS Category 1 who are medically assessed and treated immediately. The outlier HCO rate was 93.9 per 100 patients.
Funnel plot of excess events
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Emergency Medicine, version 6
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1.2 ATS Category 2 - medically assessed and treated within 10 minutes (H)
Numerator Number of patients allocated ATS Category 2 who are medically assessed and treated within 10 minutes of arrival time.
Denominator Number of patients attending the ED triaged to ATS Category 2.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2009 202 305,923 401,818 76.1 71.1 94.6 74,108 21,020 2010 189 326,509 424,335 76.9 71.4 94.1 72,997 19,990 2011 192 337,154 429,578 78.5 72.8 94.2 67,659 17,557 2012 175 342,295 427,940 80.0 75.8 93.3 57,091 15,898 2013 171 352,359 434,253 81.1 78.2 93.3 52,758 15,653 2014 144 355,016 445,243 79.7 77.3 93.5 61,432 21,310 2015 134 338,380 441,226 76.7 73.8 91.8 66,807 21,267 2016 134 358,925 469,845 76.4 75.4 92.4 75,109 29,713 23,068 # per 100 patients
In 2016, there were 226 records from 134 HCOs. The annual rate was 76.4 per 100 patients.
Trends
The fitted rate improved from 78.0 to 78.3, a change of 0.27 per 100 patients.
Trend plot of rates and centiles by year
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Emergency Medicine, version 6
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Variation between strata Rates by State
Year Stratum No.
HCOs Total
numerator Total
denominator Stratum
rate# Standard
error Stratum
gains 2016 NSW 49 141,790 170,861 83.0 1.29 Qld 39 89,395 133,591 66.9 1.45 21,440
SA 6 15,235 23,002 66.3 3.50 3,845
Vic 22 43,243 52,471 82.4 2.32
WA 10 54,746 71,335 76.8 1.99 4,428
Other 8 14,516 18,585 78.2 3.90
# per 100 patients
Boxplot of Rates by State
Variation between HCOs
In 2016, the potential gains totalled 75,109 more patients allocated ATS Category 2 who are medically assessed and treated within 10 minutes.
Outliers
In 2016, there were 35 outlier records from 24 outlier HCOs whose combined excess was 23,068 fewer patients allocated ATS Category 2 who are medically assessed and treated within 10 minutes. The outlier HCO rate was 59.5 per 100 patients.
Funnel plot of excess events
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1.3 ATS Category 3 - medically assessed and treated within 30 minutes (H)
Numerator Number of patients allocated to ATS Category 3 who are medically assessed and treated within 30 minutes of arrival time.
Denominator Number of patients attending the ED triaged to ATS Category 3.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2009 196 913,533 1,471,912 62.1 57.1 94.0 470,665 111,507 2010 189 944,298 1,505,321 62.7 57.7 94.9 483,586 109,433 2011 191 957,859 1,512,380 63.3 59.0 93.0 448,160 96,102 2012 174 938,009 1,474,348 63.6 62.0 92.5 425,296 96,468 2013 169 933,406 1,414,796 66.0 65.2 93.1 383,626 96,308 2014 143 949,451 1,405,462 67.6 66.0 93.3 362,466 94,484 2015 134 872,059 1,358,373 64.2 63.2 93.1 392,807 100,380 2016 134 911,677 1,421,800 64.1 63.0 91.4 387,208 181,484 113,054 # per 100 patients
In 2016, there were 226 records from 134 HCOs. The annual rate was 64.1 per 100 patients.
Trends
The fitted rate improved from 62.6 to 65.7, a change of 3.1 per 100 patients.
Trend plot of rates and centiles by year
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Emergency Medicine, version 6
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Variation between strata Rates by State
Year Stratum No.
HCOs Total
numerator Total
denominator Stratum
rate# Standard
error Stratum
gains 2016 NSW 49 403,373 524,155 77.0 1.37 Qld 39 242,148 408,723 59.2 1.55 72,388 SA 6 21,658 67,039 32.3 3.82 29,916 Vic 22 126,600 165,719 76.4 2.43 WA 10 72,993 180,264 40.5 2.33 65,689 Other 8 44,905 75,900 59.2 3.59 13,490 # per 100 patients
Boxplot of Rates by State
Variation between HCOs
In 2016, the potential gains totalled 387,208 more patients allocated ATS Category 3 who are medically assessed and treated within 30 minutes.
Outliers
In 2016, there were 44 outlier records from 26 outlier HCOs whose combined excess was 113,054 fewer patients allocated ATS Category 3 who are medically assessed and treated within 30 minutes. The outlier HCO rate was 43.7 per 100 patients.
Funnel plot of excess events
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1.4 ATS Category 4 - medically assessed and treated within 60 minutes (H)
Numerator Number of patients allocated to ATS Category 4 who are medically assessed and treated within 60 minutes of arrival time.
Denominator Number of patients attending the ED triaged to ATS Category 4.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2009 192 1,321,348 1,992,113 66.3 58.5 95.8 586,271 131,700 2010 189 1,312,941 1,957,075 67.1 59.0 97.4 592,708 123,966 2011 191 1,364,385 1,983,203 68.8 62.6 95.3 525,322 112,229 2012 174 1,294,548 1,844,177 70.2 65.0 95.1 459,878 98,146 2013 169 1,234,333 1,688,952 73.1 67.8 96.1 389,588 87,081 2014 143 1,219,760 1,637,503 74.5 69.5 95.3 340,957 86,059 2015 133 1,089,167 1,488,599 73.2 69.6 95.4 330,243 80,616 2016 134 1,071,845 1,452,040 73.8 70.7 94.1 294,389 103,350 82,523 # per 100 patients
In 2016, there were 226 records from 134 HCOs. The annual rate was 73.8 per 100 patients.
Trends
The fitted rate improved from 66.4 to 75.2, a change of 8.8 per 100 patients. After allowing for the changing composition of HCOs contributing over the period, the trend remained significant. The rate change was 8.5 per 100 patients.
Trend plot of rates and centiles by year
Overlay Plot
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Emergency Medicine, version 6
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Variation between strata Rates by State
Year Stratum No.
HCOs Total
numerator Total
denominator Stratum
rate# Standard
error Stratum
gains 2016 NSW 49 472,410 583,066 81.0 1.07 Qld 39 247,031 330,350 74.8 1.42 20,631 SA 6 26,888 58,700 45.8 3.36 20,660 Vic 22 143,947 179,180 80.3 1.93 WA 10 125,110 216,553 57.8 1.75 50,317 Other 8 56,459 84,191 67.1 2.81 11,743 # per 100 patients
Boxplot of Rates by State
Variation between HCOs
In 2016, the potential gains totalled 294,389 more patients allocated ATS Category 4 who are medically assessed and treated within 60 minutes.
Outliers
In 2016, there were 53 outlier records from 34 outlier HCOs whose combined excess was 82,523 fewer patients allocated ATS Category 4 who are medically assessed and treated within 60 minutes. The outlier HCO rate was 58.7 per 100 patients.
Funnel plot of excess events
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Emergency Medicine, version 6
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1.5 ATS Category 5 - medically assessed and treated within 120 minutes (H)
Numerator Number of patients allocated to ATS Category 5 who are medically assessed and treated within 120 minutes of arrival time.
Denominator Number of patients attending the ED triaged to ATS Category 5.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2009 192 449,071 523,221 85.8 81.0 99.0 68,854 23,300 2010 188 432,772 505,188 85.7 80.4 99.2 68,497 23,621 2011 189 404,267 467,581 86.5 82.7 99.0 58,671 17,854 2012 172 355,372 404,517 87.9 85.8 98.6 43,346 14,095 2013 168 323,256 356,783 90.6 88.4 98.6 28,486 9,819 2014 142 303,263 343,194 88.4 88.0 98.4 34,391 16,000 2015 132 254,985 280,588 90.9 88.4 98.6 21,586 8,340 2016 133 246,875 270,331 91.3 88.8 98.2 18,510 5,119 6,619 # per 100 patients
In 2016, there were 224 records from 133 HCOs. The annual rate was 91.3 per 100 patients.
Trends
The fitted rate improved from 85.1 to 91.2, a change of 6.0 per 100 patients. After allowing for the changing composition of HCOs contributing over the period, the trend remained significant. The rate change was 6.0 per 100 patients.
Trend plot of rates and centiles by year
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Emergency Medicine, version 6
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Variation between strata Rates by State
Year Stratum No.
HCOs Total
numerator Total
denominator Stratum
rate# Standard
error Stratum
gains 2016 NSW 49 105,874 113,636 93.2 0.68 Qld 39 53,402 57,026 93.6 0.96 SA 6 10,773 13,771 78.3 1.94 2,109 Vic 21 38,212 41,416 92.3 1.12 WA 10 19,142 22,237 86.1 1.53 1,667 Other 8 19,472 22,245 87.6 1.53 1,343 # per 100 patients
Boxplot of Rates by State
Variation between HCOs
In 2016, the potential gains totalled 18,510 more patients allocated ATS Category 5 who are medically assessed and treated within 120 minutes.
Outliers
In 2016, there were 38 outlier records from 25 outlier HCOs whose combined excess was 6,619 fewer patients allocated ATS Category 5 who are medically assessed and treated within 120 minutes. The outlier HCO rate was 81.5 per 100 patients.
Funnel plot of excess events
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1.6 Patients who left the ED after triage without being seen (L)
Numerator Number of patients who presented to the ED and did not wait after being triaged. Denominator Number of patients who presented to the ED.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
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2011 20 16,246 391,087 4.15 1.83 6.40 9,091 3,795 2012 30 49,351 1,008,322 4.89 1.39 6.65 35,371 10,048 2013 40 49,830 1,277,111 3.90 1.29 5.04 33,326 11,572 2014 32 42,819 1,157,075 3.70 1.82 4.71 21,717 8,237 2015 42 43,630 1,312,959 3.32 1.38 4.31 25,510 9,801 2016 53 47,454 1,406,335 3.37 1.21 4.29 30,426 16,052 12,234 # per 100 patients
In 2016, there were 87 records from 53 HCOs. The annual rate was 3.4 per 100 patients.
Trends
The fitted rate improved from 4.7 to 3.2, a change of 1.5 per 100 patients. After allowing for the changing composition of HCOs contributing over the period, the trend remained significant. The rate change was 1.5 per 100 patients.
Trend plot of rates and centiles by year
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Variation between strata Rates by State
Year Stratum No.
HCOs Total
numerator Total
denominator Stratum
rate# Standard
error Stratum
gains 2016 NSW 25 20,865 740,448 2.82 0.31 4,920 Qld 6 3,848 127,302 3.02 0.74 SA 6 9,258 164,352 5.63 0.65 5,715 Vic 9 9,883 206,891 4.77 0.58 5,417 Other 7 3,600 167,342 2.15 0.64 # per 100 patients
Boxplot of Rates by State
Variation between HCOs
In 2016, the potential gains totalled 30,426 fewer who leave the ED after triage without being seen, corresponding to a reduction by approximately one half.
Outliers
In 2016, there were 23 outlier records from 15 HCOs whose combined excess was 12,234 more who leave the ED after triage without being seen. The outlier HCO rate was 5.8 per 100 patients.
Funnel plot of excess events
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ST-segment elevated myocardial infarction (STEMI) management
2.1 STEMI patients who receive thrombolytic therapy within 30 minutes (H)
Rationale
Prompt reperfusion is the primary objective of ST-segment elevated myocardial infarction (STEMI) management to reduce the risk of death or long-term disability.
Numerator Number of patients with STEMI who receive thrombolytic therapy as their primary treatment within 30 minutes of presentation to the ED.
Denominator Number of patients with STEMI requiring thrombolysis who receive thrombolytic therapy as their primary treatment after presentation to the ED.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 10 72 116 62.1 27.5 61.9 # per 100 patients
In 2016, there were 10 records from 10 HCOs. The annual rate was 62.1 per 100 patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
There were no potential gains in 2016.
Outliers
There were no outlier HCOs in 2016.
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2.2 Time to balloon opening within 90 minutes (H)
Numerator Number of patients with STEMI requiring a percutaneous coronary intervention (PCI) as their primary treatment that have a door-to-balloon inflation time within 90 minutes of presentation to the ED.
Denominator Number of patients with STEMI requiring a percutaneous coronary intervention (PCI) as their primary treatment after presentation to the ED.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 4 171 211 81.0 80.9 81.0 # per 100 patients
In 2016, there were four records from four HCOs. The annual rate was 81.0 per 100 patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
There were no potential gains in 2016.
Outliers
There were no outlier HCOs in 2016.
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2.3 Time to balloon opening within 60 minutes (H)
Numerator Number of patients with STEMI requiring a percutaneous coronary intervention (PCI) as their primary treatment that have a door-to-balloon inflation time within 60 minutes of presentation to the ED.
Denominator Number of patients with STEMI requiring a percutaneous coronary intervention (PCI) as their primary treatment after presentation to the ED.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 1 10 29 34.5 34.5 34.5 # per 100 patients
In 2016, there was one record from one HCO. The annual rate was 34.5 per 100 patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
There were no potential gains in 2016.
Outliers
There were no outlier HCOs in 2016.
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Emergency department mental health presentations
3.1 Mental health patients admitted from the ED within 4 hours (H)
Rationale
The emergency department is responsible for the initial assessment and management of mental health patients with an acute issue and unnecessary delay in this process can potentially result in poorer patient outcomes.
Numerator Number of mental health admitted patients whose total ED time from time of arrival is within 4 hours.
Denominator Number of mental health patients who were admitted to the ED.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
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numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 21 2,873 7,976 36.0 23.5 65.6 2,356 625 # per 100 mental health patients
In 2016, there were 21 records from 21 HCOs. The annual rate was 36.0 per 100 mental health patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
In 2016, the potential gains totalled 2,356 more admitted mental health patients whose total ED time is less than four hours.
Outliers
In 2016, there were five outlier records from five outlier HCOs whose combined excess was 625 fewer admitted mental health patients whose total ED time is less than four hours. The outlier HCO rate was 13.3 per 100 mental health patients.
Funnel plot of excess events
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3.2 Mental health patients discharged from the ED within 4 hours (H)
Numerator Number of mental health discharged patients whose total ED time from time of arrival is within 4 hours.
Denominator Number of mental health patients who were discharged from the ED.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
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numerator Total
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2016 18 3,274 5,828 56.2 41.2 83.9 1,614 764 649 # per 100 mental health patients
In 2016, there were 18 records from 18 HCOs. The annual rate was 56.2 per 100 mental health patients.
Variation between strata Rates by State
Year Stratum No.
HCOs Total
numerator Total
denominator Stratum
rate# Standard
error Stratum
gains 2016 NSW 7 575 1,785 32.6 9.35 764 Qld 5 1,410 1,863 75.4 9.15 Other 6 1,289 2,180 59.0 8.46 # per 100 mental health patients
Boxplot of Rates by State
Variation between HCOs
In 2016, the potential gains totalled 1,614 more discharged mental health patients whose total ED time is less than four hours.
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Outliers
In 2016, there were five outlier records from five outlier HCOs whose combined excess was 649 fewer discharged mental health patients whose total ED time is less than four hours. The outlier HCO rate was 26.6 per 100 mental health patients.
Funnel plot of excess events
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3.3 Mental health patients who did not wait following clinical documentation (L)
Numerator Number of mental health patients presenting to the ED who did not wait after having clinical information documented about their presenting complaint.
Denominator Number of mental health patients presenting to the ED.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2011 7 268 6,483 4.13 0.60 3.73 229 93 2012 15 1,537 37,810 4.07 1.07 8.24 1,132 601 2013 20 1,680 31,185 5.39 1.46 5.71 1,224 364 2014 14 1,366 24,795 5.51 1.52 7.34 989 263 2015 15 971 27,107 3.58 0.84 4.37 744 367 2016 18 639 18,991 3.36 0.83 2.43 482 441 311 # per 100 mental health patients
In 2016, there were 27 records from 18 HCOs. The annual rate was 3.4 per 100 mental health patients.
Trends
The fitted rate improved from 5.0 to 4.0, a change of 0.97 per 100 mental health patients.
Trend plot of rates and centiles by year
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Variation between strata Rates by State
Year Stratum No.
HCOs Total
numerator Total
denominator Stratum
rate# Standard
error Stratum
gains 2016 NSW 7 86 8,091 1.11 0.85 Qld 5 32 3,520 0.99 1.29 Other 6 521 7,380 6.97 0.89 441 # per 100 mental health patients
Boxplot of Rates by State
Variation between HCOs
In 2016, the potential gains totalled 482 fewer mental health patients who did not wait following clinical documentation, corresponding to a reduction by approximately three quarters.
Outliers
In 2016, there were two outlier records from one HCO whose combined excess was 311 more mental health patients who did not wait following clinical documentation. The outlier HCO rate was 10.7 per 100 mental health patients.
Funnel plot of excess events
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Critical care
4.1 ED time within 4 hours for ICU admissions (H)
Rationale
The time spent in the emergency department (ED) and the time delay from the ED decision to admit a patient to the actual admission to a critical care location may impact on patient outcomes. The identification of patients at-risk of clinical deterioration is crucial for the prevention of potential adverse outcomes or the need for a rapid response system (RRS) call within a few hours of ward admission.
Numerator Number of patients presenting to the ED and transferred to the ICU who had a total ED time within 4 hours.
Denominator Number of patients presenting to the ED who are transferred to the ICU.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 16 2,247 4,972 45.2 41.6 64.5 962 249 # per 100 patients
In 2016, there were 16 records from 16 HCOs. The annual rate was 45.2 per 100 patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
In 2016, the potential gains totalled 962 more ED patients transferred to the ICU whose total ED time is less than four hours.
Outliers
In 2016, there were three outlier records from three outlier HCOs whose combined excess was 249 fewer ED patients transferred to the ICU whose total ED time is less than four hours. The outlier HCO rate was 28.1 per 100 patients.
Funnel plot of excess events
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4.2 Rapid response system call within 4 hours of admission to the ward from the ED (L)
Numerator Number of rapid response system calls within 4 hours of being admitted to the ward from the ED.
Denominator Number of patients admitted to the ward from the ED.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 3 28 12,192 0.23 0.11 0.44 14 8 # per 100 patients
In 2016, there were three records from three HCOs. The annual rate was 0.23 per 100 patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
In 2016, the potential gains totalled 14 fewer rapid response system calls within 4 hours of admission to the ward from the ED, corresponding to a reduction by approximately one half.
Outliers
In 2016, there was one outlier record from one HCO whose combined excess was 8 more rapid response system calls within 4 hours of admission to the ward from the ED. The outlier HCO rate was 0.49 per 100 patients.
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Sepsis management
5.1 Time of antibiotic administration for paediatric patients within 60 minutes (H)
Rationale
The early diagnosis and initiation of treatment, including the administration of antibiotics, is crucial in the management of sepsis in adult and paediatric patients.
Numerator Number of paediatric patients who presented to the ED with a primary diagnosis of sepsis and received antibiotics within 60 minutes of arrival.
Denominator Number of paediatric patients who presented to the ED with a primary diagnosis of sepsis.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 2 15 45 33.3 33.3 33.4 # per 100 paediatric patients
In 2016, there were two records from two HCOs. The annual rate was 33.3 per 100 paediatric patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
There were no potential gains in 2016.
Outliers
There were no outlier HCOs in 2016.
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5.2 Time of antibiotic administration for adult patients within 60 minutes (H)
Numerator Number of adult patients who presented to the ED with a primary diagnosis of sepsis and received antibiotics within 60 minutes of arrival.
Denominator Number of adult patients who presented to the ED with a primary diagnosis of sepsis.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 3 123 188 65.4 58.7 74.7 17 # per 100 adult patients
In 2016, there were three records from three HCOs. The annual rate was 65.4 per 100 adult patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
In 2016, the potential gains totalled 17 more adult patients with a primary diagnosis of sepsis who receive antibiotics within 60 minutes of arrival.
Outliers
There were no outlier HCOs in 2016.
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Discharge communication
6.1 Documented evidence of clinical management plan provided to an ongoing care provider (H)
Rationale
Discharge planning and provision of information to patients and ongoing care providers have been shown to facilitate the continuum of care and ultimately improve patient outcomes.
Numerator Number of completed episodes where an ongoing care provider is provided with discharge communication following the discharge of the patient from the ED.
Denominator Number of patients who were discharged from the ED.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 6 31,703 41,453 76.5 57.4 92.2 6,505 3,522 # per 100 patients
In 2016, there were six records from six HCOs. The annual rate was 76.5 per 100 patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
In 2016, the potential gains totalled 6,505 more patients whose ongoing care provider is provided with discharge communication from the ED.
Outliers
In 2016, there were two outlier records from two outlier HCOs whose combined excess was 3,522 fewer patients whose ongoing care provider is provided with discharge communication from the ED. The outlier HCO rate was 57.4 per 100 patients.
Funnel plot of excess events
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6.2 Documented evidence of patient-centred discharge information and instructions provided to the patient or carer (H)
Numerator Number of completed episodes where a patient or patient’s carer is provided with discharge information and instruction prior to discharge from the ED.
Denominator Number of patients who were discharged from the ED.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 4 10,995 18,965 58.0 56.3 83.2 4,778 # per 100 patients
In 2016, there were four records from four HCOs. The annual rate was 58.0 per 100 patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
In 2016, the potential gains totalled 4,778 more patients/carers provided with patient-centred discharge information and instructions.
Outliers
There were no outlier HCOs in 2016.
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Pain management
7.1 Documented initial pain assessment at triage (H)
Rationale
Despite evidence-based pain management guidelines being widely available and the relief of pain perceived as a high priority for both patients and clinicians, administration of analgesia in Australian and overseas emergency departments is often insufficient.
Numerator Number of patients who presented to the ED and had a documented initial pain assessment at triage.
Denominator Number of patients who presented to the ED.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 4 24,754 51,933 47.7 5.96 100 27,177 12,052 # per 100 patients
In 2016, there were four records from four HCOs. The annual rate was 47.7 per 100 patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
In 2016, the potential gains totalled 27,177 more ED patients who have a documented initial pain assessment.
Outliers
In 2016, there was one outlier record from one outlier HCO whose combined excess was 12,052 fewer ED patients who have a documented initial pain assessment. The outlier HCO rate was 6.0 per 100 patients.
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7.2 Analgesic therapy within 30 minutes for all patients with moderate or severe pain (H)
Numerator Number of patients who presented to the ED with moderate or severe pain and received analgesic therapy within 30 minutes of documented initial pain assessment.
Denominator Number of patients who presented to the ED with moderate or severe pain.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 3 1,114 5,181 21.5 20.6 80.5 3,057 # per 100 patients
In 2016, there were three records from three HCOs. The annual rate was 21.5 per 100 patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
In 2016, the potential gains totalled 3,057 more ED patients with moderate or severe pain who receive analgesic therapy within 30 minutes.
Outliers
There were no outlier HCOs in 2016.
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7.3 Documented pain reassessment within 30 minutes of analgesic therapy (H)
Numerator Number of patients who presented to the ED and who had a documented initial pain assessment and then had a documented pain reassessment within 30 minutes of receiving analgesic therapy.
Denominator Number of patients who presented to the ED and had a documented initial pain assessment and received analgesic therapy.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 1 38 50 76.0 76.0 76.0 # per 100 patients
In 2016, there was one record from one HCO. The annual rate was 76.0 per 100 patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
There were no potential gains in 2016.
Outliers
There were no outlier HCOs in 2016.
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Unplanned re-attendance
8.1 Patients who have an unplanned re-attendance to the ED within 48 hours of initial presentation and who require admission (L)
Rationale
Patients who have an unplanned re-attendance to the emergency department (ED) shortly after discharge may represent compromised clinical care.
Numerator Number of patients who have unplanned re-attendance to the ED within 48 hours of initial presentation and who require admission.
Denominator Number of patients who were discharged from the ED.
Desirable level: Low High Not specified
Type of Indicator: Process Outcome Structure
Year No.
HCOs Total
numerator Total
denominator Rate# Rate#
(20) Rate#
(80) Centile
Gains Stratum
Gains Outlier Gains
2016 16 5,788 230,441 2.51 0.65 2.29 4,298 2,201 # per 100 patients
In 2016, there were 16 records from 16 HCOs. The annual rate was 2.5 per 100 patients.
Variation between strata
There were no significant stratum differences in 2016.
Variation between HCOs
In 2016, the potential gains totalled 4,298 fewer patients who have an unplanned re-attendance to the ED within 48 hours and who require admission, corresponding to a reduction by approximately two thirds.
Outliers
In 2016, there were two outlier records from two HCOs whose combined excess was 2,201 more patients who have an unplanned re-attendance to the ED within 48 hours and who require admission. The outlier HCO rate was 10.0 per 100 patients.
Funnel plot of excess events
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Characteristics of contributing HCOs Public/ Private and Metropolitan/ Non-metro total denominators and number of HCOs by clinical indicator
All indicators Combined
Public % Private % Metropolitan % Non-metro % Total
Emergency Medicine Total HCOs 122 89% 15 11% 76 55% 61 45% 137
Indicators by Topic
Waiting time
Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 1.1 ATS Category 1 - medically assessed and treated immediately (H)
HCOs 111 90% 13 10% 72 58% 52 42% 124
Denominator 28,623 99% 234 1% 24,581 85% 4,276 15% 28,857
1.2 ATS Category 2 - medically assessed and treated within 10 minutes (H)
HCOs 119 89% 15 11% 76 57% 58 43% 134
Denominator 457,196 97% 12,649 3% 382,179 81% 87,666 19% 469,845
1.3 ATS Category 3 - medically assessed and treated within 30 minutes (H)
HCOs 119 89% 15 11% 76 57% 58 43% 134
Denominator 1,361,380 96% 60,420 4% 1,141,371 80% 280,429 20% 1,421,800
1.4 ATS Category 4 - medically assessed and treated within 60 minutes (H)
HCOs 119 89% 15 11% 76 57% 58 43% 134
Denominator 1,371,645 94% 80,395 6% 1,105,531 76% 346,509 24% 1,452,040
1.5 ATS Category 5 - medically assessed and treated within 120 minutes (H)
HCOs 118 89% 15 11% 76 57% 57 43% 133
Denominator 253,633 94% 16,698 6% 191,852 71% 78,479 29% 270,331
1.6 Patients who left the ED after triage without being seen (L)
HCOs 44 83% 9 17% 37 70% 16 30% 53
Denominator 1,325,782 94% 80,553 6% 1,171,606 83% 234,729 17% 1,406,335
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ST-segment elevated myocardial infarction (STEMI) management
Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 2.1 STEMI patients who receive thrombolytic therapy within 30 minutes (H)
HCOs 10 100% - 0% - - - - 10
Denominator 116 100% - 0% 19 16% 97 84% 116
2.2 Time to balloon opening within 90 minutes (H)
HCOs - - - - - - - - 4
Denominator 201 95% 10 5% 211 100% - 0% 211
2.3 Time to balloon opening within 60 minutes (H)
HCOs - - - - - - - - 1
Denominator 29 100% - 0% 29 100% - 0% 29
Emergency department mental health presentations
Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 3.1 Mental health patients admitted from the ED within 4 hours (H)
HCOs 21 100% - 0% 16 76% 5 24% 21
Denominator 7,976 100% - 0% 7,109 89% 867 11% 7,976
3.2 Mental health patients discharged from the ED within 4 hours (H)
HCOs 18 100% - 0% - - - - 18
Denominator 5,828 100% - 0% 4,552 78% 1,276 22% 5,828
3.3 Mental health patients who did not wait following clinical documentation (L)
HCOs 18 100% - 0% 13 72% 5 28% 18
Denominator 18,991 100% - 0% 16,362 86% 2,629 14% 18,991
Critical care
Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 4.1 ED time within 4 hours for ICU admissions (H)
HCOs - - - - - - - - 16
Denominator 4,889 98% 83 2% 4,390 88% 582 12% 4,972
4.2 Rapid response system call within 4 hours of admission to the ward from the ED (L)
HCOs - - - - - - - - 3
Denominator 9,303 76% 2,889 24% 6,747 55% 5,445 45% 12,192
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Sepsis management
Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 5.1 Time of antibiotic administration for paediatric patients within 60 minutes (H)
HCOs - - - - - - - - 2
Denominator 45 100% - 0% 45 100% - 0% 45
5.2 Time of antibiotic administration for adult patients within 60 minutes (H)
HCOs - - - - - - - - 3
Denominator 188 100% - 0% 188 100% - 0% 188
Discharge communication
Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 6.1 Documented evidence of clinical management plan provided to an ongoing care provider (H)
HCOs - - - - - - - - 6
Denominator 40,663 98% 790 2% 41,453 100% - 0% 41,453
6.2 Documented evidence of patient-centred discharge information and instructions provided to the patient or carer (H)
HCOs - - - - - - - - 4
Denominator 18,434 97% 531 3% 18,965 100% - 0% 18,965
Pain management
Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 7.1 Documented initial pain assessment at triage (H)
HCOs - - - - - - - - 4
Denominator 42,964 83% 8,969 17% 51,933 100% - 0% 51,933
7.2 Analgesic therapy within 30 minutes for all patients with moderate or severe pain (H)
HCOs - - - - - - - - 3
Denominator 5,181 100% - 0% 5,181 100% - 0% 5,181
7.3 Documented pain reassessment within 30 minutes of analgesic therapy (H)
HCOs - - - - - - - - 1
Denominator 50 100% - 0% 50 100% - 0% 50
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Unplanned re-attendance
Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 8.1 Patients who have an unplanned re-attendance to the ED within 48 hours of initial presentation and who require admission (L)
HCOs 16 100% - 0% - - - - 16
Denominator 230,441 100% - 0% 202,568 88% 27,873 12% 230,441
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Summary of Results Waiting time
1.1 ATS Category 1 - medically assessed and treated immediately (H) In 2016, there were 206 records from 124 HCOs. The annual rate was 99.6 per 100 patients.The fitted rate improved from 99.2 to 99.6, a change of 0.39 per 100 patients. There was relatively little variation between HCOs and so the potential gains were small in 2016. In 2016, there were six outlier records from four outlier HCOs whose combined excess was 74 fewer patients allocated ATS Category 1 who are medically assessed and treated immediately. The outlier HCO rate was 93.9 per 100 patients
1.2 ATS Category 2 - medically assessed and treated within 10 minutes (H) In 2016, there were 226 records from 134 HCOs. The annual rate was 76.4 per 100 patients.The fitted rate improved from 78.0 to 78.3, a change of 0.27 per 100 patients. In 2016, the potential gains totalled 75,109 more patients allocated ATS Category 2 who are medically assessed and treated within 10 minutes. In 2016, there were 35 outlier records from 24 outlier HCOs whose combined excess was 23,068 fewer patients allocated ATS Category 2 who are medically assessed and treated within 10 minutes. The outlier HCO rate was 59.5 per 100 patients.
1.3 ATS Category 3 - medically assessed and treated within 30 minutes (H) In 2016, there were 226 records from 134 HCOs. The annual rate was 64.1 per 100 patients.The fitted rate improved from 62.6 to 65.7, a change of 3.1 per 100 patients. In 2016, the potential gains totalled 387,208 more patients allocated ATS Category 3 who are medically assessed and treated within 30 minutes. In 2016, there were 44 outlier records from 26 outlier HCOs whose combined excess was 113,054 fewer patients allocated ATS Category 3 who are medically assessed and treated within 30 minutes. The outlier HCO rate was 43.7 per 100 patients.
1.4 ATS Category 4 - medically assessed and treated within 60 minutes (H) In 2016, there were 226 records from 134 HCOs. The annual rate was 73.8 per 100 patients.The fitted rate improved from 66.4 to 75.2, a change of 8.8 per 100 patients. After allowing for the changing composition of HCOs contributing over the period, the trend remained significant. The rate change was 8.5 per 100 patients. In 2016, the potential gains totalled 294,389 more patients allocated ATS Category 4 who are medically assessed and treated within 60 minutes. In 2016, there were 53 outlier records from 34 outlier HCOs whose combined excess was 82,523 fewer patients allocated ATS Category 4 who are medically assessed and treated within 60 minutes. The outlier HCO rate was 58.7 per 100 patients.
1.5 ATS Category 5 - medically assessed and treated within 120 minutes (H) In 2016, there were 224 records from 133 HCOs. The annual rate was 91.3 per 100 patients.The fitted rate improved from 85.1 to 91.2, a change of 6.0 per 100 patients. After allowing for the changing composition of HCOs contributing over the period, the trend remained significant. The rate change was 6.0 per 100 patients. In 2016, the potential gains totalled 18,510 more patients allocated ATS Category 5 who are medically assessed and treated within 120 minutes. In 2016, there were 38 outlier records from 25 outlier HCOs whose combined excess was 6,619 fewer patients allocated ATS Category 5 who are medically assessed and treated within 120 minutes. The outlier HCO rate was 81.5 per 100 patients.
1.6 Patients who left the ED after triage without being seen (L) In 2016, there were 87 records from 53 HCOs. The annual rate was 3.4 per 100 patients.The fitted rate improved from 4.7 to 3.2, a change of 1.5 per 100 patients. After allowing for the changing composition of HCOs contributing over the period, the trend remained significant. The rate change was 1.5 per 100 patients. In 2016, the potential gains totalled 30,426 fewer who leave the ED after triage without being seen, corresponding to a reduction by approximately one half. In 2016, there were 23 outlier records from 15 HCOs whose combined excess was 12,234 more who leave the ED after triage without being seen. The outlier HCO rate was 5.8 per 100 patients.
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ST-segment elevated myocardial infarction (STEMI) management
2.1 STEMI patients who receive thrombolytic therapy within 30 minutes (H) In 2016, there were 10 records from 10 HCOs. The annual rate was 62.1 per 100 patients. There were no potential gains in 2016.
2.2 Time to balloon opening within 90 minutes (H) In 2016, there were four records from four HCOs. The annual rate was 81.0 per 100 patients. There were no potential gains in 2016.
2.3 Time to balloon opening within 60 minutes (H) In 2016, there was one record from one HCO. The annual rate was 34.5 per 100 patients. There were no potential gains in 2016.
Emergency department mental health presentations
3.1 Mental health patients admitted from the ED within 4 hours (H) In 2016, there were 21 records from 21 HCOs. The annual rate was 36.0 per 100 mental health patients. In 2016, the potential gains totalled 2,356 more admitted mental health patients whose total ED time is less than four hours. In 2016, there were five outlier records from five outlier HCOs whose combined excess was 625 fewer admitted mental health patients whose total ED time is less than four hours. The outlier HCO rate was 13.3 per 100 mental health patients.
3.2 Mental health patients discharged from the ED within 4 hours (H) In 2016, there were 18 records from 18 HCOs. The annual rate was 56.2 per 100 mental health patients. In 2016, the potential gains totalled 1,614 more discharged mental health patients whose total ED time is less than four hours. In 2016, there were five outlier records from five outlier HCOs whose combined excess was 649 fewer discharged mental health patients whose total ED time is less than four hours. The outlier HCO rate was 26.6 per 100 mental health patients.
3.3 Mental health patients who did not wait following clinical documentation (L) In 2016, there were 27 records from 18 HCOs. The annual rate was 3.4 per 100 mental health patients.The fitted rate improved from 5.0 to 4.0, a change of 0.97 per 100 mental health patients. In 2016, the potential gains totalled 482 fewer mental health patients who did not wait following clinical documentation, corresponding to a reduction by approximately three quarters. In 2016, there were two outlier records from one HCO whose combined excess was 311 more mental health patients who did not wait following clinical documentation. The outlier HCO rate was 10.7 per 100 mental health patients.
Critical care
4.1 ED time within 4 hours for ICU admissions (H) In 2016, there were 16 records from 16 HCOs. The annual rate was 45.2 per 100 patients. In 2016, the potential gains totalled 962 more ED patients transferred to the ICU whose total ED time is less than four hours. In 2016, there were three outlier records from three outlier HCOs whose combined excess was 249 fewer ED patients transferred to the ICU whose total ED time is less than four hours. The outlier HCO rate was 28.1 per 100 patients.
4.2 Rapid response system call within 4 hours of admission to the ward from the ED (L) In 2016, there were three records from three HCOs. The annual rate was 0.23 per 100 patients. In 2016, the potential gains totalled 14 fewer rapid response system calls within 4 hours of admission to the ward from the ED, corresponding to a reduction by approximately one half. In 2016, there was one outlier record from one HCO whose combined excess was 8 more rapid response system calls within 4 hours of admission to the ward from the ED. The outlier HCO rate was 0.49 per 100 patients.
Sepsis management
5.1 Time of antibiotic administration for paediatric patients within 60 minutes (H) In 2016, there were two records from two HCOs. The annual rate was 33.3 per 100 paediatric patients. There were no potential gains in 2016.
5.2 Time of antibiotic administration for adult patients within 60 minutes (H) In 2016, there were three records from three HCOs. The annual rate was 65.4 per 100 adult patients. In 2016, the potential gains totalled 17 more adult patients with a primary diagnosis of sepsis who receive antibiotics within 60 minutes of arrival.
Emergency Medicine, version 6
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Discharge communication
6.1 Documented evidence of clinical management plan provided to an ongoing care provider (H) In 2016, there were six records from six HCOs. The annual rate was 76.5 per 100 patients. In 2016, the potential gains totalled 6,505 more patients whose ongoing care provider is provided with discharge communication from the ED. In 2016, there were two outlier records from two outlier HCOs whose combined excess was 3,522 fewer patients whose ongoing care provider is provided with discharge communication from the ED. The outlier HCO rate was 57.4 per 100 patients.
6.2 Documented evidence of patient-centred discharge information and instructions provided to the patient or carer (H) In 2016, there were four records from four HCOs. The annual rate was 58.0 per 100 patients. In 2016, the potential gains totalled 4,778 more patients/carers provided with patient-centred discharge information and instructions.
Pain management
7.1 Documented initial pain assessment at triage (H) In 2016, there were four records from four HCOs. The annual rate was 47.7 per 100 patients. In 2016, the potential gains totalled 27,177 more ED patients who have a documented initial pain assessment. In 2016, there was one outlier record from one outlier HCO whose combined excess was 12,052 fewer ED patients who have a documented initial pain assessment. The outlier HCO rate was 6.0 per 100 patients.
7.2 Analgesic therapy within 30 minutes for all patients with moderate or severe pain (H) In 2016, there were three records from three HCOs. The annual rate was 21.5 per 100 patients. In 2016, the potential gains totalled 3,057 more ED patients with moderate or severe pain who receive analgesic therapy within 30 minutes.
7.3 Documented pain reassessment within 30 minutes of analgesic therapy (H) In 2016, there was one record from one HCO. The annual rate was 76.0 per 100 patients. There were no potential gains in 2016.
Unplanned re-attendance
8.1 Patients who have an unplanned re-attendance to the ED within 48 hours of initial presentation and who require admission (L) In 2016, there were 16 records from 16 HCOs. The annual rate was 2.5 per 100 patients. In 2016, the potential gains totalled 4,298 fewer patients who have an unplanned re-attendance to the ED within 48 hours and who require admission, corresponding to a reduction by approximately two thirds. In 2016, there were two outlier records from two HCOs whose combined excess was 2,201 more patients who have an unplanned re-attendance to the ED within 48 hours and who require admission. The outlier HCO rate was 10.0 per 100 patients.
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