The National Emergency Access Target (NEAT) and the 4‐hour rule: time to review the target

Abstract

As NEAT compliance rates increased, in-hospital mortality of emergency admissions declined, although this direct inverse relationship is lost once total and admitted NEAT compliance rates exceed certain levels. This inverse association between NEAT compliance rates and in-hospital mortality should be considered when formulating targets for access to emergency care.

Impact of the four‐hour National Emergency Access Target on 30 day mortality, access block and chronic emergency department overcrowding in Australian emergency departments

“…[9][10][11][12]15 Our study found significant mortality reduction post-4HR only in WA (−0.28 per 1000 per quarter or a rate of about −1% per quarter relative to the baseline age-standardised mortality rate of 27.53 per 1000; Table 2). [9][10][11][12]15 Our study found significant mortality reduction post-4HR only in WA (−0.28 per 1000 per quarter or a rate of about −1% per quarter relative to the baseline age-standardised mortality rate of 27.53 per 1000; Table 2).…”

“…[9][10][11][12]15 Longer and larger linked longitudinal data for the post-4HR with longer periods at low access block levels would be required to assess whether the post-4HR reduction in excess mortality in WA can be replicated across Australia. The impact on mortality was a principal concern underpinning its introduction.…”

“…1,2,6,[8][9][10][11] Two Canadian studies identified chronic ED overcrowding as a systemic problem that can happen because of prolonged strain on hospital and healthcare resources. 9,16 In this paper, the two policies have been abbreviated as 4HR. 14 In April 2009, the state government of Western Australia (WA) introduced a version of the 4-Hour Target.…”

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

“…28 As most of the sites were major referral hospitals affected by access block, the intervention was expected to have the most impact on those hospitals. 28 As most of the sites were major referral hospitals affected by access block, the intervention was expected to have the most impact on those hospitals.…”

Should we scrap the target of a maximum four hour wait in emergency departments?

“…22 Several Australian studies that have evaluated time based targets have shown reduced mortality associated with introducing a time based target. [23][24][25] New Zealand's six hour target has also been associated with decreased mortality. 26 Certainly, it does not increase mortality, and, perhaps counterintuitively, it does not increase attendances at emergency departments.…”