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Gaming National Emergency Access Target performance using Emergency Treatment Performance definitions and emergency department short stay units
Author(s) -
Hession Michael,
Forero Roberto,
Man Nicola W,
Penza Luke,
McDonald Wade
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 - 10.1111/1742-6723.13295
Subject(s) - medicine , emergency department , accreditation , medical emergency , metric (unit) , emergency medicine , overcrowding , triage , operations management , nursing , medical education , economics , economic growth
Objective To evaluate potential gaming of the 4 h ED length of stay metric known as the National Emergency Access Target (NEAT) in Australia and Emergency Treatment Performance (ETP) in New South Wales (NSW). Methods Descriptive statistical analysis was used to recalculate and compare the scores for NEAT and the NSW ETP using variations in the definitions of their measurement on 32 184 presentations during 2016. A computer simulation using a discrete event model illustrated the effect of the use of ED short stay beds on the ETP scores. Results Using the timestamp of the intent to discharge a patient, called, ‘ready for departure’ instead of the time of a patient physically leaving the department, resulted in an apparent 6% performance improvement. A local interpretation of the NSW state definition of the ‘transferred’ patient resulted in the ETP for ‘admitted’ patients improving by 16%. The discrete event model demonstrated that without changing patient length of stay, ETP scores can be improved by optimising the time of the admit decision or increasing the number of ED short stay beds. Conclusions The opportunity of NEAT may be squandered unless gaming of the definitions and use of ED short stay beds is addressed. We argue that the longstanding issue of ‘departure time’ should be defined as ‘physically leaving’ the department, in accordance with the Australasian College for Emergency Medicine (ACEM) definition. Patient occupancy is a real measure of ED resource use and NSW and national recommendations should be adjusted. ACEM accreditation of EDs should include review of their application of NEAT definitions to ensure they truly reflect patient flow processes.