Do the national performance tables really indicate the performance of accident and emergency departments?

Abstract

OBJECTIVE: To determine the current practice of nurse triage in accident and emergency departments in England, and to examine the relation between triage systems and performance in the Department of Health comparative performance guide. DESIGN: A postal questionnaire was sent to all consultants in accident and emergency medicine in England. RESULTS: 151 responses were analysed, representing 72% of the departments seeing at least 15,000 new patients annually. Triage systems vary widely throughout departments, ranging between advanced triage, partial triage, and "eyeballing". There is no standardisation of the process or duration of triage. There appears to be no standard method of measuring the time to immediate assessment. There is no correlation between the quality of initial assessment and performance in the tables. CONCLUSION: The national performance figures do not correlate with the quality of the initial assessment; comparisons based on these figures are therefore misleading. More effective performance indicators are available, which would provide a truer indication of the quality of accident and emergency services.