The impact of Australian healthcare reforms on emergency department time-based process outcomes: An interrupted time series study

Abstract

BackgroundIn 2011, the Australian government introduced national healthcare reforms aimed at increasing the timeliness and quality of hospital care. The healthcare reforms included, but were not limited to, emergency department (ED) time-based targets, financial incentives, and public performance reporting of hospital data. We sought to evaluate the impact of the national healthcare reforms on ED time-based process outcomes.MethodsA quasi-experimental study of ED presentations from 2006 to 2016 in the state of Victoria, Australia. Uncontrolled, interrupted time-series analyses were used to evaluate, by hospital peer groups, the effect of national healthcare reforms on: patient wait times for treatment; treatment within recommended time; and patient departure within four hours of arrival in ED.ResultsThere were small improvements in ED time-based process outcomes following the introduction of the national healthcare reforms. These occurred in most hospital peer groups immediately and over the longer term, across the various triage categories. The largest improvements occurred in small hospitals and smallest improvements in medium sized hospitals. ED time-based targets, now abolished by the Australian government, were not achieved in any hospital peer groups.ConclusionsOur findings suggest that national healthcare reforms had the potential to prompt fundamental changes in ED processes leading to significant improvements in ED performances across most hospital peer groups but were generally unable to reach the ED targets imposed nationally. ED performances also varied by hospital peer groups. Attention to ED time-based process outcomes within hospital peer groups may provide insights into hospital practices that could improve the quality and efficiency of ED care.

Review article: Has the implementation of time‐based targets for emergency department length of stay influenced the quality of care for patients? A systematic review of quantitative literature

“…Twenty‐one studies met inclusion criteria for the primary analysis 6,7,9,11,18–34 . Another 12 studies were included in the secondary analysis 35–46 .…”

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

“… 37 38 The FHR programme was also incorporated into the NHR under the National Emergency Access Target (NEAT) implemented across Australia since January 2012. 32 State and territory governments are given significant financial incentives from the federal government if the 4-hour rule is achieved in 90% patients presenting at ED by 2015. 32 The multiple reforms targeting processes in both ED and its interface inpatient unit have broad impacts in healthcare.…”

“… 32 State and territory governments are given significant financial incentives from the federal government if the 4-hour rule is achieved in 90% patients presenting at ED by 2015. 32 The multiple reforms targeting processes in both ED and its interface inpatient unit have broad impacts in healthcare. Studies evaluating the impact of the 2012 reform showed a significant improvement in timeliness of care for patients presenting at ED and reduce in length of stay in ED, patient mortality and access bed block.…”

“…Rates of CT use by year for each of these anatomic regions are presented using postestimation predictive margins. 31 The difference-in-differences approach was undertaken post hoc to examine whether there was a significant difference in the effect of the National Emergency Access Target programme (targeted in improving quality of care through the Four Hour Rule programme and activity-based funding implemented in Australia in January 2012) 32 on the rate of CT use across sex, age group, triage code and main symptom category.…”

Emergency Department Clinical Risk

“…To guarantee the safety practices and avoid AE, we have to do implementation strategy in many settings [15][16][17][18][19][20][21][22][23][24][25]…”