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Emergency department targets: a watershed for outcomes research?
Author(s) -
Richardson Drew B
Publication year - 2012
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja12.10003
Subject(s) - citation , emergency department , library science , medicine , psychology , medical education , computer science , nursing
MJA 196 (2) · 6 February 2012 126 ational Emergency Access Targets (NEAT) are now in place and will progressively require a higher proportion of emergency department (ED) patients to be treated and to leave within a set time frame over the next 4 years. The stated aim of the NEAT is to improve patient safety and patient access; their implied aim is to reduce overcrowding. The funding model recognises that the causes of overcrowding often lie outside of the ED, providing states with upfront resources with which to reengineer hospital processes.1 From a researcher’s perspective, this “natural experiment” will provide an opportunity to address two major questions: what are the best hospital models of care for rapid and safe ED flow and what is the effect on patient outcomes? Overcrowding in the ED is strongly associated with excess patient mortality, both inside and outside of hospital.2-4 It is largely accepted that overcrowding contributes to dysfunction that might increase mortality, but demonstrating causality requires strength of association, consistency, specificity, temporality, a dose–response relationship, biological plausibility, coherence, reversibility and consideration of alternative explanations (the Bradford–Hill criteria5). Given the considerable difficulties that would be encountered in attempting a randomised trial, observers have been waiting for mortality reports from a setting where effort has been made to reduce overcrowding. The first such evidence of apparent reversibility is published in this issue of the Journal. Geelhoed and de Klerk6 describe the first year of Western Australia’s 4-hour rule in Perth hospitals, finding a 13% overall reduction in mortality in the three large hospitals where ED overcrowding also diminished. This certainly adds something to the evidence for a causal relationship between overcrowding and unnecessary patient deaths. The 80 fewer deaths recorded in the Emergency department targets: a watershed for outcomes research?