Senior clinician views regarding introduction of a ‘time to specialist’ quality measure for unselected emergency admissions

The reorganisation of hospital emergency care aims to promote rapid access to specialists. In this study, we sought views from senior clinicians regarding the introduction of a ‘time to specialist’ (TTS) measure to evaluate healthcare delivery. We conducted a thematic analysis of transcripts from semistructured interviews (n=13) with clinical leads in a large National Health Service (NHS) Foundation Trust. Three main themes were identified, each with two subcategories: TTS as an appropriate measure (utility and acceptability); recording of TTS information (defining specialist contact and collection of time data); and impact (patient care and service efficiency). Interviewees perceived that a TTS target might improve clinical care for patients with severe illness and service efficiency for milder presentations. There was uncertainty about other patient groups and the definition of ‘specialist’ in this context. Clinical leads recognised that TTS might be helpful for describing changes in the provision of services, but the impact for patients was unclear because of heterogeneity in presentation and severity of illness for unselected admissions, and challenges in the definition of ‘specialist’ relative to individual clinical need.