Impact of the four-hour National Emergency Access Target on 30 day mortality, access block and chronic emergency department overcrowding in Australian emergency departments

Forero, R; Man, N; Ngo, H; Mountain, D; Mohsin, M; Fatovich, D; Toloo, G; Celenza, A; FitzGerald, G; McCarthy, S; Richardson, D; Xu, F; Gibson, N; Nahidi, S; Hillman, K

Impact of the four-hour National Emergency Access Target on 30 day mortality, access block and chronic emergency department overcrowding in Australian emergency departments

Forero, R Man, N Ngo, H Mountain, D Mohsin, M Fatovich, D Toloo, G Celenza, A FitzGerald, G McCarthy, S Richardson, D Xu, F

Gibson, N Nahidi, S Hillman, K

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Publication Type:: Journal Article
Citation:: EMA - Emergency Medicine Australasia, 2019, 31 (1), pp. 58 - 66
Issue Date:: 2019-02-01

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Field	Value	Language
dc.contributor.author	Forero, R	en_US
dc.contributor.author	Man, N	en_US
dc.contributor.author	Ngo, H	en_US
dc.contributor.author	Mountain, D	en_US
dc.contributor.author	Mohsin, M	en_US
dc.contributor.author	Fatovich, D	en_US
dc.contributor.author	Toloo, G	en_US
dc.contributor.author	Celenza, A	en_US
dc.contributor.author	FitzGerald, G	en_US
dc.contributor.author	McCarthy, S	en_US
dc.contributor.author	Richardson, D	en_US
dc.contributor.author	Xu, F https://orcid.org/0000-0002-8465-5834	en_US
dc.contributor.author	Gibson, N	en_US
dc.contributor.author	Nahidi, S	en_US
dc.contributor.author	Hillman, K	en_US
dc.date.available	2018-06-27	en_US
dc.date.issued	2019-02-01	en_US
dc.identifier.citation	EMA - Emergency Medicine Australasia, 2019, 31 (1), pp. 58 - 66	en_US
dc.identifier.issn	1742-6731	en_US
dc.identifier.uri	http://hdl.handle.net/10453/135464
dc.description.abstract	© 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine Objective: Previous research reported strong associations between ED overcrowding and mortality. We assessed the effect of the Four-Hour Rule (4HR) intervention (Western Australia (WA) 2009), then nationally rolled out as the National Emergency Access Target (Australia 2012) policy on mortality and patient flow. Methods: A longitudinal cohort study of a population-wide 4HR, for 16 hospitals across WA, New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD). Mortality trends were analysed for 2–4 years before and after 4HR using interrupted time series technique. Main outcomes included the effect of 4HR on patient flow markers; admitted 30 day mortality trends; and patient flow marker performance during the study period. Results: There were 40 281 deaths from 952 726 emergency admissions. All jurisdictions, except ACT, had improved flow and access block after 4HR. Age-standardised mortality was decreasing before the intervention. Post-intervention, WA had a significant reduction in mortality rate of −0.28 per 1000 patients per quarter (P = 0.040) while QLD had mixed results and NSW/ACT trends did not change significantly. Meta-regression of aggregated data for hospitals grouped on flow performances did not show significant mortality changes associated with the policy. Conclusions: The 4HR was introduced as a means of driving hospital performance by applying a time target. Patient flow improved, but the evidence for mortality benefit is controversial with improvement only in WA. Further research with more representative data from a larger number of hospitals over a longer time across Australia is needed to increase statistical power to detect long-term effects of the policy.	en_US
dc.relation.ispartof	EMA - Emergency Medicine Australasia	en_US
dc.relation.isbasedon	10.1111/1742-6723.13151	en_US
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject.classification	Emergency & Critical Care Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Hospitalization	en_US
dc.subject.mesh	Hospital Mortality	en_US
dc.subject.mesh	Regression Analysis	en_US
dc.subject.mesh	Cohort Studies	en_US
dc.subject.mesh	Longitudinal Studies	en_US
dc.subject.mesh	Crowding	en_US
dc.subject.mesh	Time Factors	en_US
dc.subject.mesh	Emergency Service, Hospital	en_US
dc.subject.mesh	Outcome Assessment (Health Care)	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Outcome Assessment, Health Care	en_US
dc.title	Impact of the four-hour National Emergency Access Target on 30 day mortality, access block and chronic emergency department overcrowding in Australian emergency departments	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	31	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1103 Clinical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access	*
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	31	en_US

Abstract:

© 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine Objective: Previous research reported strong associations between ED overcrowding and mortality. We assessed the effect of the Four-Hour Rule (4HR) intervention (Western Australia (WA) 2009), then nationally rolled out as the National Emergency Access Target (Australia 2012) policy on mortality and patient flow. Methods: A longitudinal cohort study of a population-wide 4HR, for 16 hospitals across WA, New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD). Mortality trends were analysed for 2–4 years before and after 4HR using interrupted time series technique. Main outcomes included the effect of 4HR on patient flow markers; admitted 30 day mortality trends; and patient flow marker performance during the study period. Results: There were 40 281 deaths from 952 726 emergency admissions. All jurisdictions, except ACT, had improved flow and access block after 4HR. Age-standardised mortality was decreasing before the intervention. Post-intervention, WA had a significant reduction in mortality rate of −0.28 per 1000 patients per quarter (P = 0.040) while QLD had mixed results and NSW/ACT trends did not change significantly. Meta-regression of aggregated data for hospitals grouped on flow performances did not show significant mortality changes associated with the policy. Conclusions: The 4HR was introduced as a means of driving hospital performance by applying a time target. Patient flow improved, but the evidence for mortality benefit is controversial with improvement only in WA. Further research with more representative data from a larger number of hospitals over a longer time across Australia is needed to increase statistical power to detect long-term effects of the policy.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/135464