A Systematic Review of the Impact of Healthcare Reforms on Access to Emergency Department and Elective Surgery Services

Abstract

This systematic review sought to identify whether health care reforms led to improvement in the emergency department (ED) length of stay (LOS) and elective surgery (ES) access in Australia, Canada, New Zealand, and the United Kingdom. The review was registered in the PROSPERO database (CRD42015016343), and nine databases were searched for peer-reviewed, English-language reports published between 1994 and 2014. We also searched relevant "grey" literature and websites. Included studies were checked for cited and citing papers. Primary studies corresponding to national and provincial ED and ES reforms in the four countries were considered. Only studies from Australia and the United Kingdom were eventually included, as no studies from the other two countries met the inclusion criteria. The reviewers involved in the study extracted the data independently using standardized forms. Studies were assessed for quality, and a narrative synthesis approach was taken to analyze the extracted data. The introduction of health care reforms in the form of time-based ED and ES targets led to improvement in ED LOS and ES access. However, the introduction of targets resulted in unintended consequences, such as increased pressure on clinicians and, in certain instances, manipulation of performance data.

Waiting Time as an Indicator for Health Services Under Strain: A Narrative Review

“…Global efforts to reduce waiting time through health policy have traditionally focused on time to elective procedures after referral and ED waiting time. 7,29,72,85 However, this method of measurement fails to recognize and/or hides other types of waiting times, including time waiting for primary care, specialist medical care, allied health appointments, and time spent physically waiting in waiting rooms. We need greater transparency regarding the range of types of waiting for health services, and systematic enquiry into the reasons or potential targets for interventions.…”

“…Ray et al 63 performed a subanalysis of 3787 respondents to the American Time Use Survey. Among respondents who reported their clinic time during the 24-hour assessment period, a median (95% CI) of 86 [83][84][85][86][87][88] minutes was spent in-clinic. 63 Those in the lowest income quartile reported a mean [95% CI] clinic time of 91 [87][88][89][90][91][92][93][94][95] minutes compared with those in the highest income quartile, who reported a mean clinic time of 72 [65][66][67][68][69][70][71][72][73][74][75][76][77][78] minutes.…”

Increasing use of CT requested by emergency department physicians in tertiary hospitals in Western Australia 2003–2015: an analysis of linked administrative data

“…41 Similarly, the NEAT may result in increasing pressure on ED physicians to achieve the 4-hour rule target. 42 A study conducted in a tertiary hospital in Australia found an increase up to 61% in the total number of imaging requests following the introduction of the 2011 reform compared with the prereform period. 43 Interestingly, this study indicated that the trend was towards more requests in CT and less radiography while other imaging techniques remained unchanged.…”

Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study

“…Targets to reduce elective surgery waiting lists are prevalent in Organization for Economic Co-operation and Development (OECD) countries,1 2 and various interventions have been explored to reduce waiting times 3. In Australia, although the National Elective Surgery Target (NEST) is an important component of hospital performance measurement,4 median waiting times for elective surgery have increased by around 2% per year over the 5 years 5.…”