Impact of the National Emergency Access Target policy on emergency departments’ performance: A time‐trend analysis for New South Wales, Australian Capital Territory and Queensland

Abstract

ED presentations continued to increase over time in all jurisdictions. NSW and QLD, but not ACT, showed significant improvements in time-based measures. Significant increases in short-stay admissions suggest a strategic change in ED process associated with NEAT implementation. Rates of unplanned ED re-attendances and those leaving at their own risk showed no evidence for adverse effects from NEAT.

When a health policy cuts both ways: Impact of the National Emergency Access Target policy on staff and emergency department performance

“…Our study also applied advanced statistical techniques that allowed an accurate evaluation of ED performance and the impact of the 4HR/NEAT across Australia. Our study had large data coverage, which has allowed us to reliably measure ED occupancy over time for each participating hospital, hence providing an accurate estimate of the extent of ED overcrowding throughout the long study period …”

“…The aim of ‘Sequential QUAN → QUAL’ approach was to explore from the ED staff point of view how they perceived their hospital's performance, and how they engaged locally in the implementation of the 4HR/NEAT. In this case, we used quantitative linked data from the participating hospitals to categorise them into high, moderate and low performance hospitals and triangulate those categories with rigorous qualitative themes identified previously …”

“…Access block, defined as admitted patients spending more than 8 h in the ED, is the principal cause of ED overcrowding and remains the major problem confronting EDs worldwide . After the introduction of a 4‐h time‐based ED performance target in the UK, it was modified and introduced in Western Australia (WA) in 2009, and then across Australia in 2012 . The Four‐Hour Rule/National Emergency Access Target (4HR/NEAT) requires that most patients presenting to an ED should be seen, admitted or discharged within 4 h, when appropriate …”

“…[1][2][3] After the introduction of a 4-h timebased ED performance target in the UK, [4][5][6] it was modified and introduced in Western Australia (WA) in 2009, and then across Australia in 2012. [7][8][9][10] The Four-Hour Rule/National Emergency Access Target (4HR/NEAT) requires that most patients presenting to an ED should be seen, admitted or discharged within 4 h, when appropriate. 7,11,12 The 4HR/NEAT policy has had an impact with modest to major improvements in access block, excess mortality 9,[13][14][15][16][17] and other patient flow and outcome measures.…”

“…7,11,12 The 4HR/NEAT policy has had an impact with modest to major improvements in access block, excess mortality 9,[13][14][15][16][17] and other patient flow and outcome measures. 7,[9][10][11]13,14,[18][19][20] However, our previous studies have also shown complex effects at the ED, hospital and health system level such as effects on quality and safety, education and training, as well as the direct impact on ED overcrowding and access block. [21][22][23] This study is based on the hypothesis that hospital performance is determined by multifactorial conditions that are not discernible by quantitative measures alone.…”