As NEAT compliance rates increased, in-hospital mortality of emergency admissions declined, although this direct inverse relationship is lost once total and admitted NEAT compliance rates exceed certain levels. This inverse association between NEAT compliance rates and in-hospital mortality should be considered when formulating targets for access to emergency care.

Conventional discharge targets like '80% by 11 a.m.' and others that spread targets across the day to balance staff workload freed up the equivalent of nine available beds for incoming patient flow, significantly reducing time spent waiting for an inpatient bed, hospital LOS and occupancy, and delivering much needed improvements in NEAT performance. While different strategies and workload distributions may suit individual hospital services, the study makes a strong case for improving 'early in the day' discharge timeliness to deliver better ED flow.

Modern hospital systems have the ability to operate efficiently above an often-prescribed 85% occupancy level, with optimal levels varying across hospitals of different size. Operating over these optimal levels leads to performance deterioration defined around occupancy choke points. Understanding these choke points and designing strategies around alleviating these flow bottlenecks would improve capacity management, reduce access block and improve patient outcomes. Effecting early discharge also helps alleviate overcrowding and related stress on the system.

EDs face rising levels of NEAT non-compliance at times when corresponding access block levels have traditionally not been a concern. A higher proportion of patients breach the target during periods that would intuitively not be flagged as flow bottlenecks. The findings support the need for service level analysis and new solutions to guide workflow reform and maximise NEAT compliance.

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The results reinforces the need for a whole-of-hospital effort to address flow bottlenecks, and identify moving a patient from emergency to inpatient care as the critical bottleneck in ED system performance.