Four hour target for EDs: The UK experience

Hughes, Geoff

doi:10.1111/j.1742-6723.2010.01326.x

Cited by 27 publications

(29 citation statements)

References 3 publications

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“…The rule that 98 % of ED patients must be seen and then admitted or discharged within 4 h of presentation to the ED ('4 h rule'), introduced in 2004, has been very effective at face value, and has led to the development of further acute care clinical indicators [16,17]. Other countries are now following the lead of the National Health Service (NHS), with the goal of ending inappropriately long waiting times [18].…”

Section: Introductionmentioning

confidence: 99%

“…However, by the early 1990s, the chaotic and disorganized system of entry to acute care, coupled with increasing patient demand, had led to overcrowded EDs, very long waits for initial assessment and then for inpatient beds, with concomitant concerns about patient safety [15,17] It was recognized at the time that the target would not be successful without a significant reorganization and 'whole system change' across the entire acute care pathway, especially acute medical and surgical services [19]. As a result, approximately £ 820,000,000 was directly invested in improving ED care in the period 1998-2007 [20].…”

Section: Introductionmentioning

confidence: 99%

“…By 2009, there were pressing concerns about the utility of the 4 h rule [17]. There had been persistent doubts about the veracity of the data reported by individual hospitals.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

confidence: 99%

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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

“…Crowding increases both mortality and costs [4-9]. This problem is international [2,5,10,11] in scope and impacts [1,2,5,10-13] governments, [10,14] insurers [7], hospitals, health care workers [11], and patients [4]. …”

Section: Introductionmentioning

confidence: 99%

Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times

et al. 2013

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BackgroundInternationally, emergency departments are struggling with crowding and its associated morbidity, mortality, and decreased patient and health-care worker satisfaction. The objective was to evaluate the addition of a MDRNSTAT (Physician (MD)-Nurse (RN) Supplementary Team At Triage) on emergency department patient flow and quality of care.MethodsPragmatic cluster randomized trial. From 131 weekday shifts (8:00–14:30) during a 26-week period, we randomized 65 days (3173 visits) to the intervention cluster with a MDRNSTAT presence, and 66 days (3163 visits) to the nurse-only triage control cluster. The primary outcome was emergency department length-of-stay (EDLOS) for patients managed and discharged only by the emergency department. Secondary outcomes included EDLOS for patients initially seen by the emergency department, and subsequently consulted and admitted, patients reaching government-mandated thresholds, time to initial physician assessment, left-without being seen rate, time to investigation, and measurement of harm.ResultsThe intervention’s median EDLOS for discharged, non-consulted, high acuity patients was 4:05 [95th% CI: 3:58 to 4:15] versus 4:29 [95th% CI: 4:19–4:38] during comparator shifts. The intervention’s median EDLOS for discharged, non-consulted, low acuity patients was 1:55 [95th% CI: 1:48 to 2:05] versus 2:08 [95th% CI: 2:02–2:14]. The intervention’s median physician initial assessment time was 0:55 [95th% CI: 0:53 to 0:58] versus 1:21 [95th% CI: 1:18 to 1:25]. The intervention’s left-without-being-seen rate was 1.5% versus 2.2% for the control (p = 0.06). The MDRNSTAT subgroup analysis resulted in significant decreases in median EDLOS for discharged, non-consulted high (4:01 [95th% CI: 3:43–4:16]) and low acuity patients (1:10 95th% CI: 0:58–1:19]), as well as physician initial assessment time (0:25 [95th% CI: 0:23–0:26]). No patients returned to the emergency department after being discharged by the MDRNSTAT at triage.ConclusionsThe intervention reduced delays and left-without-being-seen rate without increased return visits or jeopardizing urgent care of severely ill patients.Trial registration numberNCT00991471 ClinicalTrials.gov

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“…The intense focus on hand hygiene guidelines and the re-packaged WHO guidelines must not divert us from all the many aspects of infection control. Cleanliness of wards and the quality of hospital cleaning services may have deteriorated, 56 basic nursing care has been gradually passed on to less experienced members of the care team, 57 higher patient-to-nurse ratios on the wards have at times resulted in sub-optimal patient care, 58 bed and side-room shortages have led to inappropriate mixing of infected, non-infected and vulnerable patients 59 and frequent transfers of patients from one unit to another in order to meet government-dictated treatment time targets, which have become more frequent in the United Kingdom, [60][61][62] can contribute to increasing environmental contamination. Prevention therefore requires a multimodal approach and co-operation between all hospital staff including management, physicians and surgeons, nursing staff, house-keeping and other affiliated services.…”

Section: After Contact With Inanimate Surfaces and Objects (Includingmentioning

confidence: 99%

The World Health Organization ‘5 Moments of Hand Hygiene’

Chou

Achan

Ramachandran

2012

The Journal of Bone and Joint Surgery. British volume

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The World Health Organization (WHO) launched the first Global Patient Safety Challenge in 2005 and introduced the ‘5 moments of hand hygiene’ in 2009 in an attempt to reduce the burden of health care associated infections. Many NHS trusts in England adopted this model of hand hygiene, which prompts health care workers to clean their hands at five distinct stages of caring for the patient. Our review analyses the scientific foundation for the five moments of hand hygiene and explores the evidence, as referenced by WHO, to support these recommendations. We found no strong scientific support for this regime of hand hygiene as a means of reducing health care associated infections. Consensus-based guidelines based on weak scientific foundations should be assessed carefully to prevent shifting the clinical focus from more important issues and to direct limited resources more effectively. We recommend caution in the universal adoption of the WHO ‘5 moments of hand hygiene’ by orthopaedic surgeons and other health care workers and emphasise the need for evidence-based principles when adopting hospital guidelines aimed at promoting excellence in clinical practice.

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Four hour target for EDs: The UK experience

Cited by 27 publications

References 3 publications

Overcrowding in emergency department: an international issue

Overcrowding in emergency department: an international issue

Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times

The World Health Organization ‘5 Moments of Hand Hygiene’

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