Emergency department overcrowding, mortality and the 4‐hour rule in Western Australia

Geelhoed, Gary C.; Klerk, Nicholas de

doi:10.5694/mja11.11159

Cited by 188 publications

(192 citation statements)

References 20 publications

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“…Task forces developed strategies that included improving efficiency and monitoring inpatients who stayed for longer periods of time. In 2008, the Western Australian government announced that EDs would adopt a 4 h rule, whereby firstly 85 % and eventually 98 % of patients would be either discharged home or admitted to a ward within 4 h of presentation [18,27,28].…”

Section: Introductionmentioning

confidence: 99%

Overcrowding in emergency department: an international issue

Somma

Paladino

Vaughan³

et al. 2014

Intern Emerg Med

331

235

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Overcrowding in the emergency department (ED) has become an increasingly significant worldwide public health problem in the last decade. It is a consequence of simultaneous increasing demand for health care and a deficit in available hospital beds and ED beds, as for example it occurs in mass casualty incidents, but also in other conditions causing a shortage of hospital beds. In Italy in the last 12-15 years, there has been a huge increase in the activity of the ED, and several possible interventions, with specific organizational procedures, have been proposed. In 2004 in the United Kingdom, the rule that 98 % of ED patients should be seen and then admitted or discharged within 4 h of presentation to the ED ('4 h rule') was introduced, and it has been shown to be very effective in decreasing ED crowding, and has led to the development of further acute care clinical indicators. This manuscript represents a synopsis of the lectures on overcrowding problems in the ED of the Third Italian GREAT Network Congress, held in Rome, 15-19 October 2012, and hopefully, they may provide valuable contributions in the understanding of ED crowding solutions.

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Section: Introductionmentioning

confidence: 99%

Overcrowding in emergency department: an international issue

Somma

Paladino

Vaughan³

et al. 2014

Intern Emerg Med

331

235

View full text Add to dashboard Cite

show abstract

“…In Australia, access block is a major cause of overcrowding in EDs [23]. Relatedly, Shih et al [6] reported that, in 1996, some patients were held in the ED of one medical center in northern Taiwan for more than 72 hours.…”

Section: Methodsmentioning

confidence: 99%

Improvements in Medical Care after Implementation of a Holistic Care Unit at a Medical Center in Taiwan

Wu¹,

Zhang²

2016

Emerg Med (Los Angel)

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Objective: A medical center in Taiwan established a Holistic Care Unit (HCU) in the emergency department (ED) to care for emergency patients while they wait for admission. Its goal was to prevent patient conditions from worsening, shorten the ED length of stay for admission, reduce complaints and disputes, and raise the quality of care. Design:If emergency physicians suggested that a patient be admitted, the patient was then transferred to the HCU. The 24-hour work day for the HCU was split into three eight-hour shifts during which on-duty physicians continued any unfinished treatments or follow-ups and accepted new patients. Results:The HCU's intervention in the ED and coordination with inpatient care significantly reduced the rate of access block from 55.29% to 50.01% (p<0.01). In addition, the ED length of stay for admission was significantly decreased from 17.06 hours to 14.13 hours (p=0.018). The percentage of patients whose condition improved while waiting for admission to the ED and who could then be released after treatment by the HCU rose from 1.3% to 4.3%. Conclusions:The HCU at this medical center is the first of its kind to combine emergency and inpatient care in Taiwan. Overcrowding was improved after establishment of the HCU at our hospital.

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“…An example of target management is the Australian Government's 2012 initiative to improve performance in public hospital Emergency Departments (ED) under the National Emergency Access Target (NEAT), which aims for 90% of all patients presenting to ED to be admitted, referred to another hospital for treatment, or discharged within four hours. Initially introduced in Western Australia, the 4-hour rule program has significantly reduced tertiary overcrowding and there is early evidence to support a fall in overall hospital mortality rate associated with improvements in access block and 4-hour performance (Geelhoed and de Klerk, 2012).…”

Section: Target Managementmentioning

confidence: 99%

“…However, a major impediment towards analyzing management practices within health care systems has been the lack of reliable empirical data on hospital management practices. The few studies that have been published are centered on specific aspects of management, such as operations management (McDermott and Stock, 2007;Vos et al, 2007), performance management (Giuffrida et al, 1999;Hafner et al, 2011), target management (Geelhoed and de Klerk, 2012) and people management (West et al, 2002;Hunter et al, 2000;Michie and West, 2004;Omar et al 2007) or in specific health care settings such as nursing . McKinsey & Co. attended to this research gap by designing a robust, multi-dimensional survey to measure hospital management practices in a holistic manner.…”

Section: Introductionmentioning

confidence: 99%

Management practices in Australian healthcare: can NSW public hospitals do better?

Agarwal

Green

Agarwal

et al. 2016

Journal of Health Organization and Management

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Purpose – The purpose of this paper is to investigate the determinants of best management practices in an Australian state-run healthcare system, namely New South Wales (NSW), and studies the impact of a range of hospital factors in driving best management practices as a means of enhancing healthcare delivery. Design/methodology/approach – This study adapts a unique survey instrument globally tested to quantify the multi-dimensional nature of hospital management practices in 42 acute care public hospitals of NSW. The authors then analysed the role of hospital-specific characteristics in driving best management practices, namely hospital size (measured by the number of hospital beds, employees and doctors), level of skill and education, degree of hospital manager autonomy and organisational hierarchy. Findings – The findings of this study show the areas of strength and potential areas of improvement in NSW hospitals. The authors find a positive association between the adoption of better management practices and hospital size (measured by the number of hospital beds and employees), level of skills and education, degree of hospital manager autonomy and organisational hierarchy. However, hospital size as measured by the number of doctors did not have a statistically significant relationship. Practical implications – This paper is of interest to both hospital administrators, clinical doctors and healthcare policy-makers who want to improve and develop strategies for better management in the healthcare sector. Originality/value – This study provides an internationally comparable robust measure of management capability in public hospitals, and contributes to the evidence-base of management practices and performance in hospitals.

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Emergency department overcrowding, mortality and the 4‐hour rule in Western Australia

Cited by 188 publications

References 20 publications

Overcrowding in emergency department: an international issue

Overcrowding in emergency department: an international issue

Improvements in Medical Care after Implementation of a Holistic Care Unit at a Medical Center in Taiwan

Management practices in Australian healthcare: can NSW public hospitals do better?

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