Impact of the Four-Hour Rule/National Emergency Access Target policy implementation on emergency department staff: A qualitative perspective of emergency department management changes

被引：3

作者：

Nahidi, Shizar ^{[1
,2
,13
]}

Forero, Roberto ^{[1
,2
,13
]}

Man, Nicola ^{[1
,2
]}

Mohsin, Mohammed ^{[3
,4
,20
,21
]}

Fitzgerald, Gerard ^{[5
,16
]}

Toloo, Ghasem ^{[5
]}

McCarthy, Sally ^{[6
,7
,16
,17
]}

Gibson, Nick ^{[8
,29
]}

Fatovich, Daniel ^{[9
,10
,11
,14
,15
,16
]}

Mountain, David ^{[11
,12
,16
,18
]}

Hillman, Ken ^{[13
]}

Sprivulis, Peter ^{[16
,18
]}

Celenza, Antonio ^{[16
,18
]}

Tridgell, Paul ^{[19
]}

Mohsin, Mohammed ^{[3
,4
,20
,21
]}

Daly, Frank ^{[16
,22
]}

Rohwedder, Elizabeth ^{[23
]}

Green, Sam ^{[23
]}

Marmara, Sarah ^{[24
]}

Fitzgerald, Gerard ^{[5
,16
]}

Burke, John ^{[16
,25
]}

Middleton, Paul ^{[16
,26
]}

Richardson, Drew ^{[16
,27
,28
]}

Gibson, Nick ^{[8
,29
]}

Braithwaite, Jeffrey ^{[30
]}

Nugus, Peter ^{[31
]}

Hanh Ngo ^{[18
]}

Man, Wing ^{[13
]}

Nahidi, Shizar ^{[1
,2
,13
]}

De Costa, Josephine ^{[13
]}

Lenne, Brydan ^{[13
]}

Toloo, Sam ^{[5
]}

机构：

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

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

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

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

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

[6] Univ New South Wales, Prince Wales Clin Sch, Sydney, NSW, Australia

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

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

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

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

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

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

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

[14] Royal Perth Hosp, Ctr Clin Res Emergency Med, Dept Emergency Med, Perth, WA, Australia

[15] Univ Western Australia, Perth, WA, Australia

[16] ACEM, West Melbourne, Vic, Australia

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

[18] Univ Western Australia, Emergency Med, Perth, WA, Australia

[19] Paul Tridgell Consulting, Sydney, NSW, Australia

[20] NSW Hlth, SWSLHD, Psychiat Res & Teaching Unit, Sydney, NSW, Australia

[21] UNSW, Sch Publ Hlth & Community Med, Sydney, NSW, Australia

[22] Dept Hlth Western Australia, South Metropolitan Hlth Serv, Perth, WA, Australia

[23] Dept Hlth Western Australia, Hlth Syst Improvement Unit, East Perth, WA, Australia

[24] NSW Minist Hlth, Sydney, NSW, Australia

[25] Royal Brisbane & Womens Hosp, Dept Emergency Med, Brisbane, Qld, Australia

[26] Australian Resuscitat Council NSW, Brookvale, NSW, Australia

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

[28] Canberra Hosp ED, Canberra, ACT, Australia

[29] Edith Cowan Univ, Perth, WA, Australia

[30] Macquarie Univ, Sydney, NSW, Australia

[31] McGill Univ, Montreal, PQ, Canada

来源：

EMERGENCY MEDICINE AUSTRALASIA | 2019年 / 31卷 / 03期

基金：

英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;

关键词：

emergency department management; Four-Hour Rule; National Emergency Access Target; qualitative research; staff perception and experience; MODEL; TIME; MORTALITY; BLOCK; RULE; CARE; TOOL;

D O I：

10.1111/1742-6723.13164

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

ObjectiveIt has been 10years since the ACEM Access Block Solutions Summit and 5years since the introduction of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) policy. The impact of this policy on ED management and on ED staff has been poorly understood. The aim of the present study was to identify changes in ED management resulting from the policy based on ED staff experiences. MethodsSemi-structured interviews were conducted and transcribed, imported to NVivo 11 and analysed using a combination of content, thematic analysis and phenomenological focus within a theoretical framework known as the logic model'. ResultsOne hundred and nineteen ED staff participated in 2015-2016 to assess the impact of the policy implementation. Participants were drawn from 16 EDs in New South Wales, Queensland, Western Australia and Australian Capital Territory. In relation to ED management, three themes were identified: changes in ED management; activities and changes driven by the hospital in relation to 4HR/NEAT; and participant experiences in relation to policy compliance by staff. ConclusionsPolicy implementation is a complex process that had both positive and negative consequences on how ED staff managed the implementation of the 4HR/NEAT policy and how it changed their work environment. Understanding the perceptions of staff involved in policy implementation has significance for the design of future implementation strategies. The biggest insight from the present study is that ED management is very complex and the policy generated multiple positive and negative changes demonstrating the wide range of processes involved in this area of health services research.

引用

页码：362 / 371

页数：10

共 31 条

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Hung, Kevin Kei Ching
Lui, Chun Tat
Kwok, Wai Shing
Lam, Wendy Wing Tak
Lau, Eric Ho Yin
Sridhar, Siddharth
Ng, Peter Yau Tak
Cheng, Chi Hung
Tsang, Tat Chi
Tsui, Matthew Sik Hon
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BMJ OPEN, 2024, 14 (02):

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