Quality statement 3: Consultant assessment and review

Quality statement

Adults admitted with a medical emergency have a timely consultant assessment and review.

Rationale

Having consultants available for timely assessment and review is associated with reduced length of stay for people admitted to hospital with a medical emergency. The frequency of consultant review is based on clinical need. Clinical review should be carried out at least daily, including at weekends and bank holidays.

Quality measures

Structure

a) Evidence of consultant availability during daytime working hours to assess adults who have a medical emergency within 6 hours of the time of admission to hospital.

Data source: Local data collection, for example, from staff rotas and service specifications. For measurement purposes, the first consultant review within a maximum of 6 hours from the time of admission to hospital has been included during the daytime working hours timeframe (normally at least 08.00 to 20.00) based on NHS England (2017) Seven Day Services Clinical Standards.

b) Evidence of consultant availability to assess adults who have a medical emergency within 14 hours of the time of admission to hospital.

Data source: Local data collection, for example, from staff rotas and service specifications. For measurement purposes timeframes have been included based on NHS England (2017) Seven Day Services Clinical Standards and Society for Acute Medicine (2017) Benchmarking audit. These align with the examples of possible considerations in NICE guideline NG94, recommendation 1.2.5.

c) Evidence of consultant availability to review adults daily who have a medical emergency after the initial consultant review is carried out.

Data source: Local data collection, for example, from staff rotas and service specifications. NHS England (2017) Seven Day Services Clinical Standards includes details of ongoing daily consultant review.

Process

a) Proportion of hospital admissions for adults with a medical emergency during the daytime working hours in which a consultant assessment is carried out within 6 hours of the time of admission to hospital.

Numerator – the number in the denominator in which a consultant assessment is carried out within 6 hours of the time of admission to hospital.

Denominator – the number of hospital admissions of adults with a medical emergency during the daytime working hours.

For measurement purposes, the daytime working hours timeframe (normally at least 08.00 to 20.00) of first consultant review within a maximum of 6 hours from the time of admission to hospital has been included based on NHS England (2017) Seven Day Services Clinical Standards.

Data source: Local data collection, for example, audit of electronic case records. NHS Digital (2018) Accident and Emergency Quality Indicators includes information on time to initial assessment.

b) Proportion of hospital admissions for adults with a medical emergency in which a consultant assessment is carried out within 14 hours of the time of admission to hospital.

Numerator – the number in the denominator in which a consultant assessment is carried out within 14 hours of the time of admission to hospital.

Denominator – the number of hospital admissions for adults with a medical emergency.

For measurement purposes, the timeframe of first consultant review within a maximum of 14 hours from the time of hospital admission has been included based on NHS England (2017) Seven Day Services Clinical Standards and Society for Acute Medicine (2017) Benchmarking audit.

Data source: Local data collection, for example, audit of electronic case records. NHS Digital (2018) Accident and Emergency Quality Indicators includes information on time to initial assessment.

c) Proportion of hospital admissions for adults with a medical emergency in which a consultant review is carried out at least once every 24 hours after the initial consultant review.

Numerator – the number in the denominator in which a consultant review is carried out at least once every 24 hours.

Denominator – the number of hospital admissions for adults with a medical emergency in which the person has had the initial consultant review.

Data source: Local data collection, for example local audit of patient records, staff rotas and service specifications. NHS England (2017) Seven Day Services Clinical Standards includes a timeframe for consultant review of at least once every 24 hours after the initial consultant review.

Outcome

Length of hospital stay for adults admitted with a medical emergency.

Data source: Local data collection, for example, local audit of patient records. NHS Digital Hospital episode statistics includes length of stay data.

What the quality statement means for different audiences

Service providers (secondary care providers including emergency departments and acute medical units) ensure that consultants are available to assess adults with a medical emergency within a maximum of 14 hours from the time of hospital admission to determine the care pathway. The frequency of consultant review is based on clinical need. Current local staffing models, the case mix presenting and the severity of illness should be considered to ensure early consultant involvement. Staff rotas may need to be reconfigured to support the timing and frequency of consultant review.

Healthcare professionals (consultants) assess adults with a medical emergency face to face as soon as possible and always within a maximum of 14 hours of the time of hospital admission. During daytime working hours a review should normally occur within a maximum of 6 hours of the time of admission. The frequency of consultant review is based on clinical need. It should be carried out at least daily, including at weekends and bank holidays.

Commissioners (clinical commissioning groups) ensure that they commission services using a service specification that states that there are consultants available to assess adults with a medical emergency within a maximum of 14 hours from the time of hospital admission and to review them daily. Commissioners monitor contracts and seek evidence that service providers have these consultants available.

Adults who are admitted to hospital with a medical emergency are seen by a consultant within 14 hours of admission, and at least once a day while they are in hospital.

Source guidance

Definition of terms used in this quality statement

Medical emergency

A life-threatening emergency, acute exacerbation of chronic illness or routine health problem that needs prompt action. A medical emergency can arise in anyone, for example in people:

  • without a previously diagnosed medical condition

  • with an acute exacerbation of underlying chronic illness

  • after surgery

  • after trauma.

[NICE's guideline on emergency and acute medical care in over 16s: service delivery and organisation, guideline introduction (glossary)]