Quality of Care

A National Survey of Geriatric Emergency Health Care: Insights into Current Practice

Original Articles, Volume 24, Issue 2, Pages 61 – 108 (2025)

Background: Emergency departments (EDs) are increasingly managing elderly patients who present unique clinical challenges. This study explores the current management practices for patients aged 75 years and older in Belgian EDs.
Methods: An electronic survey was sent to 105 heads of Belgian EDs. The Collected data underwent descriptive analysis.
Results: Geriatric protocols, adapted equipment, availability of geriatricians, and paramedical staff improve the quality of care for older patients in the EDs. However, the limited use of geriatric scores, prolonged stays in the ED, and lack of hospital beds are frequent problems that negatively impact quality of care.
Conclusion: Given the variable level of care provided to the elderly in the EDs, care protocols should be standardized and improved at the national scale.

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Respiratory rates observed over 15 seconds compared with rates measured using the RRate app. Practice-based evidence from an observational study of acutely ill adult medical patients during their hospital admission

Original Articles, Volume 19, Issue 1, Pages 1 - 60 (2020)

Background: counting respiratory rate over 60 seconds can be impractical in a busy clinical setting.

Methods: 870 respiratory rates of 272 acutely ill medical patients estimated from observations over 15 seconds and those calculated by a computer algorithm were compared.

Results: The bias of 15 seconds of observations was 1.85 breaths per minute and 0.11 breaths per minute for the algorithm derived rate, which took 16.2 SD 8.1 seconds. The algorithm assigned 88% of respiratory rates their correct National Early Warning Score points, compared with 80% for rates from 15 seconds of observation.

Conclusion: The respiratory rates of acutely ill patients are measured nearly as quickly and more reliably by a computer algorithm than by observations over 15 seconds.

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How well are heart rates measured by pulse oximeters and electronic sphygmomanometers? Practice-based evidence from an observational study of acutely ill medical patients during hospital admission

Original Articles, Volume 18, Issue 3, Pages 137 – 204 (2019)

Background: heart rates generated by pulse oximeters and electronic sphygmomanometers in acutely ill patients may not be the same as those recorded by ECG

Methods: heart rates recorded by an oximeter and an electronic sphygmomanometer were compared with electrocardiogram (ECG) heart rates measured on acutely ill medical patients.

Results: 1010 ECGs were performed on 217 patients while they were in the hospital. The bias between the oximeter and the ECG measured heart rate was -1.37 beats per minute (limits of agreement -22.6 to 19.9 beats per minute), and the bias between the sphygmomanometer and the ECG measured heart rate was -0.14 beats per minute (limits of agreement -22.2 to 21.9 beats per minute). Both devices failed to identify more than half the ECG recordings that awarded 3 NEWS points for heart rate.

Conclusion: Heart rates of acutely ill patients are not reliably measured by pulse oximeter or electronic sphygmomanometers.

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The Team at Work – The Society for Acute Medicine’s Benchmarking Audit 2014 (SAMBA’14)

Research Audit and Clinical Practice, Volume 14, Issue 3, Pages 97 - 144 (2015)

Abstract

Background: The Society for Acute Medicine’s Benchmarking Audit (SAMBA) serves as a tool for Acute Medical Units to compare and improve their quality of care.

Aim: To audit the performance of Acute Medical Units against clinical quality indicators, standards by the Royal College of Physicians and Specialist Societies relevant to the practice of Acute Medicine.

Methods: An online survey of unit profiles and staffing levels on the audit day was followed by a 24-hour data collection on Thursday the 19th of June 2014 for all patients seen by the local Acute Medicine teams as part of the general medical take. Patients were followed-up for 72 hours. We reviewed the impact of staffing levels on performance indicators.

Results: 66 Acute Medical Units admitted 2333 patients during the 24-hour period. Compliance with the quality standards of SAM was as follows: 84% of patients had an early warning score recorded within 30 minutes of admission, 81% of patients had been seen by a competent decision maker within four hours and 73% of patients were seen by a consultant physician within the appropriate period of time. Only 56% of patients received a standard of care compatible with all three quality standards. We found no relation between unit characteristics, staffing and performance indicator.

Conclusion: There remains a gap between the standard described by the quality indicators and the performance of Acute Medical Units during a one-day audit.

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‘State of the Nation’ – The Society for Acute Medicine’s Benchmarking Audit 2013 (SAMBA ’13)

Research Audit and Clinical Practice, Volume 12, Issue 4, Pages 185 - 252 (2013)

Abstract

Background: Benchmarking is important to improve quality of care.

Aim: To audit the performance of Acute Medical Units (AMUs) against the clinical quality indicators published by the Society for Acute Medicine (SAM).

Methods: 24-hour data collection on the 20th of June 2013 with follow-up data at 72 hours.

Results: 43 units submitted data on 1425 patients. 76% of patients had early warning scores recorded within 30 minutes of admission, 95% of patients had been seen by a competent decision maker within four hours. 79% of patients were seen by a consultant physicians within the appropriate period of time.

Conclusion: The difference in compliance with quality standards between UK units opens opportunities for learning. The reasons why some units perform better than others require further investigation.

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A Day in the Life of the AMU– The Society for Acute Medicine’s Benchmarking Audit 2012 (SAMBA ‘12)

Research Audit and Clinical Practice, Volume 12, Issue 2, Pages 65 - 124 (2013)

Abstract

Background: The absence of published data for benchmarking serves as a disincentive for Acute Medical Units to improve care.

Aim: To test feasibility of a national audit in Acute Medicine for compliance with common standards

Methods: On line questionnaire with summary data for patients admitted to participating Acute Medicine Units over a 24-hour-period.

Results: 30 units submitted summary data. The mean number of admission was 36 (SD 14). Compliance with standards around timing of junior and senior review was highly variable. In almost all other standards only a small number of units achieved high reliability with compliance of more than 90%.

Conclusion: SAMBA provides a data set that can be used for local and national benchmarking and quality improvement work. Annual audit might be beneficial to track improvements.

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Towards ‘Sepsis with Optimal Treatment’: Evaluating the sepsis care pathway in Acute Medicine and identifying scope for systems improvement

Research Audit and Clinical Practice, Volume 12, Issue 1, Pages 1 - 64 (2013)

Abstract

Sepsis commonly presents to the acute medicine unit (AMU). Timely recognition and treatment can reduce the significant associated mortality, but United Kingdom AMUs and emergency departments are often inadequately equipped to manage sepsis with early-goal directed therapy.

We conducted an observational study of 50 consecutive patients admitted with severe sepsis. Demographic, physiological and microbiological data, and information about the provision and timing of care were collected in real time.

Treatment fell below “surviving sepsis” targets with only 28% of patients receiving sufficient fluid, and 64% receiving antibiotics within 3 hours, associated with delays in seeing physicians; however despite this mortality was lower than the nationally quoted average (14% at 90 days).

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