Providing the best possible care poses the challenge of continuously assessing and improving the clinical and organisational performance of individual EDs based on validated criteria. The most convincing way to achieve this is through clinical and quality-of-care assessment research. Unfortunately, to date, the possibility of doing research in emergency medicine has clashed with sustainability issues. The vast number of patients visiting an ED (60-90.000 patients access a medium-sized ED per year) and staff shortages that chronically afflict these departments make ad hoc data collections unattainable. Clinical research in emergency medicine has therefore been mostly confined to large academic centres, which can count on research-dedicated organisations and teams.