There is increasing concern that medical care is of variable quality, with variable outcomes, safety, costs and experience for patients. 1 Despite substantial efforts to improve patient safety, some studies suggest little evidence of reductions in adverse events. 2 Furthermore, there is limited agreement about what outcomes are expected and whether increased expenditure results in a real improvement in outcome or experience. In emergency medicine, many countries have developed specific indicators to help drive improvements in patient care. 3a??5 Most of these are time based and there is a lack of consensus regarding which indicators are high priority and what an appropriate framework for measuring quality should look like.