Increased burden on metropolitan urological services: The era of the Australian National Emergency Access Targets (NEAT or the “4-h target”)

Abstract

Background:The National Emergency Access Targets (NEAT) was introduced in Australia in 2011 and guides the clearance of presentations within 4-h of initial presentation from the Emergency Department (ED). We aim to assess the impact of the introduction of NEAT on acute urological services at a large metropolitan center.Methods:A retrospective cohort study was performed and data were collected from electronic patient management systems. The control group was represented by ED presentations between June and September 2011, 1 year prior to the introduction of NEAT. The two study groups consisted of ED presentations between June and September 2012 and 2013, respectively. Outcome measures included time to the ureteric stent and scrotal exploration, inpatient length of stay (IPLOS), out-of-hours operating, and hospital mortality rates.Results:Across the three study periods, a total of 76,935 patients were assessed by the EDs of the health service. 225 urological inpatient episodes were included across all periods with a trend showing increasing numbers of admissions (P = 0.003). For patients admitted under the urological service: Waiting room time and ED length of stay decreased significantly (P < 0.001). Proportion of operative cases decreased insignificantly (P = 0.275). Time from emergency presentation to emergency ureteric stent remained unchanged, however, proportions of procedures performed out-of-hours showed an increasing trend (P < 0.001). A significant increase in inter-unit transfer was observed, however, median IPLOS and mortality for operative and nonoperative cases remain unchanged.Conclusions:Concerning urological admissions, the implementation of NEAT has been associated with improvement in ED key performance indicators. Such changes have been correlated with reductions in operative cases and increases in out-of-hours emergency operating. Further research is required to evaluate the direct effect of NEAT on urological patient care.

The impact of acute surgical unit rostering on National Emergency Access Targets during the COVID‐19 pandemic: a single hospital experience

“…An Australian study on NEAT targets conducted by urologists in Western Australia yielded similar results, with only a modest reduction in ED LOS and no improvement in time to theatre. They noted an increase in inappropriate referrals and an increase in inter‐unit transfer of undifferentiated patients who did not require specialist input 11 . No hospital in Australia has consistently met NEAT targets >85% 12 and clinicians need to be wary that standardized triage and referral targets do not compromise their patient care.…”

“…They noted an increase in inappropriate referrals and an increase in inter‐unit transfer of undifferentiated patients who did not require specialist input. 11 No hospital in Australia has consistently met NEAT targets >85% 12 and clinicians need to be wary that standardized triage and referral targets do not compromise their patient care.…”

A systematic review of dedicated models of care for emergency urological patients

“…General surgery's elective activities within traditional models of care were particularly prone to interruption, due to caring for more than twice as many emergency patients as any other surgical specialty [ 31 ]. Local forces such as governmental targets to limit patient time in the emergency department have also incentivized surgical staff allocation to emergency patients [ 32 , 33 ]. Additionally, there are more general surgeons than any other type [ 34 ], providing capacity to dedicate separate personnel in the ASU model.…”

Qualitative perspectives of nurse managers on mixed‐gender accommodation in a regional hospital in Australia

“…National Emergency Access Targets (NEAT) reinforce the pressure for the timely flow of patients through the ED. NEAT was introduced in Australia in 2011 to reduce ED wait times and improve the quality of patient care after studies showed the impaired flow of emergency admissions could adversely affect patient outcomes (Perera et al., 2018; Shetty et al., 2017). These targets contribute to the pressure on nursing staff to view patient flow as the priority rather than seeing the whole patient, taking into consideration their needs and preferences.…”