When a health policy cuts both ways: Impact of the National Emergency Access Target policy on staff and emergency department performance.
ED performance
Four Hour Rule
National Emergency Access Target
mixed methods research
staff perception
Journal
Emergency medicine Australasia : EMA
ISSN: 1742-6723
Titre abrégé: Emerg Med Australas
Pays: Australia
ID NLM: 101199824
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
25
05
2019
revised:
09
08
2019
accepted:
26
08
2019
pubmed:
9
10
2019
medline:
19
8
2021
entrez:
10
10
2019
Statut:
ppublish
Résumé
To explore the impact of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) on staff and ED performance. A mixed-methods study design was used to link performance data from 16 participating hospitals with the experiences reported by 119 ED staff during policy implementation. Quantitative and qualitative measures were triangulated to identify the staff and organisational effects on hospital performance. An overall score was developed to categorise hospitals into: high, moderate and low performers, then compared with four qualitative themes: social factors, ED management, ED outcomes and 4HR/NEAT compliance. Key factors identified were stress and morale; intergroup dynamics; interaction with patients; resource management; education and training; financial incentives; impact on quality and safety; perceived improvements on access block and overcrowding. High performing hospitals reported increased stress and decreased morale, decreased staff-patient communication and staff shortages; significant changes in ED management and effective use of the whole-of-hospital approach. Moderate performing hospitals reported similar characteristics to a lesser degree, and the perception that 4HR/NEAT did not impact ED practice. Low performing hospitals also reported increased stress and low morale and a less effective whole-of-hospital approach. ED staff also reported a reduction in communication with patients. There was strong evidence of an association between high stress and low morale and the implementation of the 4HR/NEAT across all levels of performance. These adverse consequences of the 4HR/NEAT implementation indicate that a more nuanced approach to efficiency improvements is required. This would balance processes measured by 4HR/NEAT against a range of other clinical and organisational performance measures.
Identifiants
pubmed: 31595671
doi: 10.1111/1742-6723.13395
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
228-239Subventions
Organisme : Australasian College for Emergency Medicine
Pays : International
Organisme : Department of Health of Western Australia
Pays : International
Organisme : NSW Agency for Clinical Innovation
Pays : International
Organisme : National Health and Medical Research Council
ID : APP1029492
Pays : International
Organisme : Ministry of Health of NSW
ID : cash contribution
Pays : International
Organisme : Queensland Emergency Medicine Research Foundation
Pays : International
Informations de copyright
© 2019 Australasian College for Emergency Medicine.
Références
Mason S, Mountain G, Turner J, Arain M, Revue E, Weber EJ. Innovations to reduce demand and crowding in emergency care: a review study. Scand. J. Trauma Resusc. Emerg. Med. 2014; 22: 55.
Weber EJ, Mason S, Carter A, Hew RL. Emptying the corridors of shame: organizational lessons from England's 4-hour emergency throughput target. Ann. Emerg. Med. 2011; 57: 79-88.e1.
Weber EJ, Mason S, Freeman JV, Coster J. Implications of England's four-hour target for quality of care and resource use in the emergency department. Ann. Emerg. Med. 2012; 60: 699-706.
Cooke M. Time and quality targets: the English experience. Improving the delivery of Emergency Care, 25-26 August 2010; Gold Coast, Queensland, 2010.
Government of Western Australia Department of Health. WA Health Emergency Demand UK Tour, 2008.
Cooke M, Fisher J, Dale J et al. Reducing attendances and waits in emergency departments: a systematic review of present innovations. Report to the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO), 2005.
Ngo H, Forero R, Mountain D et al. Impact of the Four-Hour Rule in Western Australian hospitals: trend analysis of a large record linkage study 2002-2013. PLoS One 2018; 13: e0193902.
Khanna S, Boyle J, Good N, Bell A, Lind J. Analysing the emergency department patient journey: discovery of bottlenecks to emergency department patient flow. Emerg. Med. Australas. 2017; 29: 18-23.
Jones P, Wells S, Harper A et al. Impact of a national time target for ED length of stay on patient outcomes. N. Z. Med. J. 2017; 130: 15-34.
Forero R, Man N, McCarthy S et al. Impact of the National Emergency Access Target policy on emergency departments' performance: a time-trend analysis for New South Wales, Australian Capital Territory and Queensland. Emerg. Med. Australas. 2019; 31: 253-61.
Goncalves-Bradley D, Khangura JK, Flodgren G, Perera R, Rowe BH, Shepperd S. Primary care professionals providing non-urgent care in hospital emergency departments. Cochrane Database Syst. Rev. 2018; 2: CD002097.
Qin S, Thompson C, Bogomolov T, Ward D, Hakendorf P. Hospital occupancy and discharge strategies: a simulation-based study. Intern. Med. J. 2017; 47: 894-9.
Sullivan C, Staib A, Khanna S et al. The National Emergency Access Target (NEAT) and the 4-hour rule: time to review the target. Med. J. Aust. 2016; 204: 354.
Staib A, Sullivan C, Griffin B, Bell A, Scott I. Report on the 4-h rule and National Emergency Access Target (NEAT) in Australia: time to review. Aust. Health Rev. 2016; 40: 319-23.
Forero R, Man N, Ngo H et al. Impact of the four-hour National Emergency Access Target on 30 day mortality, access block and chronic emergency department overcrowding in Australian emergency departments. Emerg. Med. Australas. 2018; 30: 30.
Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med. J. Aust. 2019; 31: 58-66.
Sprivulis PC, Da Silva J-A, Jacobs IG, Frazer ARL, Jelinek GA. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments.(Published erratum appears in Med. J. Aust. 2006; 184(12): 616). Med. J. Aust. 2006; 184: 208-12.
Jones P, Wells S, Ameratunga S. Towards a best measure of emergency department crowding: lessons from current Australasian practice. Emerg. Med. Australas. 2018; 30: 214-21.
Gill SD, Lane SE, Sheridan M, Ellis E, Smith D, Stella J. Why do ‘fast track’ patients stay more than four hours in the emergency department? An investigation of factors that predict length of stay. Emerg. Med. Australas. 2018; 30: 641-7.
Tse R, Thompson N, Moscova M, Sindhusake D, Shetty A, Young N. Do delays in radiology lead to breaches in the 4-hour rule? Clin. Radiol. 2016; 71: 523-31.
Nahidi S, Forero R, McCarthy S et al. A qualitative analysis of perceptions and experiences of emergency department staff in relation to implementation and outcomes of the Four-Hour Rule/National Emergency Access Target in Australia. Emerg. Med. Australas. 2019; 31: 378-86.
Nahidi S, Forero R, Man N et al. Impact of 4HR/NEAT policy implementation on emergency department staff: a qualitative perspective of ED management changes. Emerg. Med. Australas. 2019; 31: 362-71.
Forero R, Nahidi S, De Costa J et al. Application of four-dimension criteria to assess rigour of qualitative research in emergency medicine. BMC Health Serv. Res. 2018; 18: 120.
Creswell JW, Plano Clark VL, Gutmannn M, Hanson WE. Advanced mixed methods research designs. In: Tashakkori A, Teddlie C, eds. Handbook of Mixed Methods in Social and Behavioral Research. Thousand Oaks, CA: Sage, 2003; 209-40.
Ivankova NV. Implementing quality criteria in designing and conducting a sequential QUAN → QUAL mixed methods study of student engagement with learning applied research methods online. J. Mixed Methods Res. 2014; 8: 25-51.
Liu SW, Chang Y, Camargo CA et al. A mixed-methods study of the quality of care provided to patients boarding in the emergency department: comparing emergency department and inpatient responsibility models. Med. Care Res. Rev. 2012; 69: 679-98.
Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scand. J. Public Health 2012; 40: 795-805.
Forero R, Nahidi S, de Costa J et al. Perceptions and experiences of emergency department staff during the implementation of the Four-Hour Rule/National Emergency Access Target Policy in Australia: a qualitative social dynamic perspective. BMC Health Serv. Res. 2019; 19: 82.
Campbell D. NHS considers scrapping Four-Hour A&E Waiting Time Targets. The Guardian 2019; 8 January.