In addition, if feasible, additional data to support the internal validity of the QI will also be collected. It is anticipated that data collection methods will include: 1. Site visit 2. Direct patient assessment 3. Review of the patient chart 4. Extraction of data from the electronic information system in ED 5. Phone follow-up at consecutive time intervals (7 and 28 days)

with patient 6. State held ED and hospital episode data. QIs will only be excluded at this point if a novel data collection method is identified (separate from the above list), and the cost of additional data collection is prohibitive. Any indicators excluded at this point will be recorded, Inhibitors,research,lifescience,medical with the justification, in the Excluded Indicators Manual. Sample size The sample size is determined in two ways Inhibitors,research,lifescience,medical using simulation methods resulting in a required sample of 480 participants. This planned sample size will have 77% power to detect reliability coefficients within an acceptable level of precision (estimated correlation Inhibitors,research,lifescience,medical among raters coefficient greater than 0.35 when the true value is 0.6 and the QI base rate is 50%). Given these parameters, for the classification analysis, we will be able to correctly classify units as poor (proportion of patients flagging a QI is less than the observed 20th percentile across facilities and the true

quality score for the facility is below the 20th percentile) with an overall 83% accuracy. The empirical c-statistic for this classification (proportion of facilities with Inhibitors,research,lifescience,medical true performance in the lowest 20% that have observed quality scores in the lowest 20%) is 0.98. Participants or study groups The minimum number required from each site will be 60 cases. We will aim to recruit 80 cases across eight units to allow for incomplete data. This will enable

a final sample size of at least 480 cases. Site selection will be influenced by case-mix Inhibitors,research,lifescience,medical and ability to recruit adequate patient numbers, with the final group allowing for representation of district, metropolitan and tertiary Emergency Departments. Inclusion criteria All patients aged 70 years and older presenting to study site emergency 10058-F4 Departments during the study period will be considered eligible for enrolment. Exclusion criteria 1. Patients who have presented to the ED and have completed else triage 2 or more hours prior to the Research Nurse being available to approach them for consent 2. Patients presenting to ED with acute illness of such severity that prevents staff from gaining consent (either from the individual or their caregiver) 3. Patients returning to the ED, after already being consented for participation at the initial ED visit. Aspects relevant to their return to ED will be identified via the phone follow up process, from chart audit and from State held data on ED visits 4.