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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
Author(s) -
Forero Roberto,
Man Nicola,
McCarthy Sally,
Richardson Drew,
Mohsin Mohammed,
Toloo Ghasem Sam,
FitzGerald Gerry,
Ngo Hanh,
Mountain David,
Fatovich Daniel,
Celenza Antonio,
Gibson Nick,
Xu Fenglian,
Nahidi Shizar,
Hillman Ken
Publication year - 2019
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.13142
Subject(s) - medicine , emergency department , odds ratio , demography , cohort , odds , emergency medicine , logistic regression , nursing , sociology
Objective To evaluate the impact of the Australian National Emergency Access Target (NEAT) policy introduced in 2012 on ED performance. Methods A longitudinal cohort study of NEAT implementation using linked data, for 12 EDs across New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between 2008 and 2013. Segmented regression in a multi‐level model was used to analyse ED performance over time before and after NEAT introduction. The main outcomes measures were ED length of stay ≤4 h, access block, number of ED presentations, short‐stay admission (≤24 h), >24 h admissions, unplanned ED re‐attendances within 7 days and ‘left at own risk’ (including ‘did not wait for assessment’). Results Two years after NEAT introduction, ED length of stay ≤4 h increased in NSW and QLD (odds ratio [OR] = 2.48 and 3.24; P < 0.001) and access block decreased (OR = 0.41 and 0.22; P < 0.001), but not in ACT (OR = 1.28; P > 0.05). ED presentations increased over time before and after NEAT introduction with a significant increase above the projected trend in NSW after NEAT (mean ratio = 1.07). Short‐stay admissions increased in QLD (OR = 2.60), ACT (OR = 1.68) and NSW (OR = 1.35). Unplanned ED re‐attendances did not change significantly. Those who left at their own risk decreased significantly in NSW and QLD (OR = 0.38 and 0.67). Conclusion ED presentations continued to increase over time in all jurisdictions. NSW and QLD, but not ACT, showed significant improvements in time‐based measures. Significant increases in short‐stay admissions suggest a strategic change in ED process associated with NEAT implementation. Rates of unplanned ED re‐attendances and those leaving at their own risk showed no evidence for adverse effects from NEAT.