Four Hour Emergency Access Standard: Expert Working Group Recommendations Report

1. Purpose

1. To ensure greater consistency in reporting of A&E performance across NHS Scotland, the Scottish Government, in conjunction with Public Health Scotland (PHS), established an expert working group to reflect on the intent of the emergency access standard and review what patients should be included in the standard now, based on new models of care and service delivery, to ensure that this can be applied as consistently as possible across NHS Scotland.

2. The group was formed of: clinical experts from across Scotland’s Health Boards; information and data representatives from Boards; Data Management and Analytical Teams from Public Health Scotland; representation from the Royal College of Emergency Medicine and officials from the Scottish Government’s Health and Social Care Directorate. The group considered the following key areas:

• Consistency of ‘planned’ attendance recording
• If ‘planned’ attendances should be included in the EAS.
• Whether patients ‘transferred out’ of A&E on a trolley/chair (e.g. to an AAU) should continue to be included in the EAS and/or if this should extend to all patients in these facilities who are not admitted, irrespective of the route they were referred in (e.g. A&E, GP, NHS24)
• If Admission Alternative Pathways should / should not be included in the EAS.

3. The focus of this report is on which patients should or should not be included in the Four Hour Emergency Access Standard (EAS).

4. This document sets out a number of recommendations to improve the consistency of recording against the EAS and reduce unwarranted variation between Health Boards. The report is split into three main sections which form the basis of the groups discussion and recommendations, namely: A&E Care; Planned Attendances and Admission Alternative Pathways.