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

被引：30

作者：

Forero, Roberto ^{[1
,2
]}

Man, Nicola ^{[1
,2
]}

Hanh Ngo ^{[3
]}

Mountain, David ^{[3
,4
]}

Mohsin, Mohammed ^{[5
,6
]}

Fatovich, Daniel ^{[3
,7
,8
]}

Toloo, Ghasem ^{[9
]}

Celenza, Antonio ^{[2
,3
]}

Fitzgerald, Gerry ^{[9
]}

McCarthy, Sally ^{[10
,11
]}

Richardson, Drew ^{[12
,13
]}

Xu, Fenglian ^{[1
]}

Gibson, Nick ^{[14
]}

Nahidi, Shizar ^{[1
,2
]}

Hillman, Ken ^{[1
,2
]}

机构：

[1] Univ New South Wales, Simpson Ctr Hlth Serv Res, Sydney, NSW 2170, Australia

[2] Ingham Inst Appl Med Res, Sydney, NSW, Australia

[3] Univ Western Australia, Fac Hlth & Med Sci, Div Emergency Med, Perth, WA, Australia

[4] Sir Charles Gairdner Hosp, Emergency Dept, Perth, WA, Australia

[5] South Western Sydney Local Hlth Dist, Psychiat Res & Teaching Unit, Sydney, NSW, Australia

[6] Univ New South Wales, Sch Psychiat, Fac Med, Sydney, NSW, Australia

[7] Royal Perth Hosp, Emergency Dept, Perth, WA, Australia

[8] Harry Perkins Inst Med Res, Ctr Clin Res Emergency Med, Perth, WA, Australia

[9] Queensland Univ Technol, Sch Publ Hlth & Social Work, Brisbane, Qld, Australia

[10] Agcy Clin Innovat, Emergency Care Inst, Sydney, NSW, Australia

[11] Prince Wales Hosp, Emergency Dept, Sydney, NSW, Australia

[12] Australian Natl Univ, Sch Med, Canberra, ACT, Australia

[13] Canberra Hosp, Emergency Dept, Canberra, ACT, Australia

[14] Edith Cowan Univ, Sch Nursing & Midwifery, Perth, WA, Australia

来源：

EMERGENCY MEDICINE AUSTRALASIA | 2019年 / 31卷 / 01期

关键词：

30 day mortality; access block; emergency department overcrowding; National Emergency Access Target; trend analysis; TIME; RULE; NEAT; ASSOCIATION;

D O I：

10.1111/1742-6723.13151

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objective: Previous research reported strong associations between ED overcrowding and mortality. We assessed the effect of the Four-Hour Rule (4HR) intervention (Western Australia (WA) 2009), then nationally rolled out as the National Emergency Access Target (Australia 2012) policy on mortality and patient flow. Methods: A longitudinal cohort study of a population-wide 4HR, for 16 hospitals across WA, New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD). Mortality trends were analysed for 2-4 years before and after 4HR using interrupted time series technique. Main outcomes included the effect of 4HR on patient flow markers; admitted 30 day mortality trends; and patient flow marker performance during the study period. Results: There were 40 281 deaths from 952 726 emergency admissions. (P = 0.040) while QLD had mixed results and NSW/ACT trends did not change significantly. Meta-regression of aggregated data for hospitals grouped on flow performances did not show significant mortality changes associated with the policy. Conclusions: The 4HR was introduced as a means of driving hospital performance by applying a time target. Patient flow improved, but the evidence for mortality benefit is controversial with improvement only in WA. Further research with more representative data from a larger number of hospitals over a longer time across Australia is needed to increase statistical power to detect long-term effects of the policy.

引用

页码：58 / 66

页数：9

共 22 条

[21] Impact of the Four-Hour Rule policy on emergency medical services delays in Australian EDs: a longitudinal cohort study
Man, Nicola Wing Young
Forero, Roberto
Ngo, Hanh
Mountain, David
FitzGerald, Gerard
Toloo, Ghasem
McCarthy, Sally
Mohsin, Mohammed
Fatovich, Daniel M.
Bailey, Paul
Bosley, Emma
Carney, Rosemary
Lai, Harry Man Xiong
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EMERGENCY MEDICINE JOURNAL, 2020, 37 (12) : 793 - 800
[22] Impact of Off-Hour Hospital Presentation on Mortality in Different Subtypes of Acute Stroke in Korea : National Emergency Department Information System Data
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