Evaluating emergency services activity at the health district level

We do not have good information on the incidence and prevalence of emergenc y conditions nor is there good research evidence on the best ways of meetin g these. There are, however, some indicators for evaluating emergency servi ces 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] depart ment, 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 n ew development is situation reporting on emergency pressures ('Sitreps'). T his provides a fortnightly and sometimes daily picture of current emergency activity as measured by key indicators such as the number of delayed disch arges from hospital, the number of cancelled operations, and the number of medical inpatients outlying on other wards. 'Sitreps' was particularly help ful in handling emergency activity at the new millennium period. We need to specify a comprehensive, valid and easily collectable data set f or assessing the quality of emergency services. This would include better w ays of forecasting for early warning purposes. This could be done by monito ring the incidence of absenteeism, the sale of over-the-counter drugs, and the number of deaths in nursing homes.