12th May 2017, Volume 130 Number 1455

Peter Jones, James Le Fevre, Alana Harper, Susan Wells, Joanna Stewart, Elana Curtis, Papaarangi Reid, Shanthi Ameratunga

In May 2009 the Ministry of Health formally announced six national health targets for public hospitals in Aotearoa New Zealand.1 One of these was the Shorter Stays in Emergency Departments…

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Summary

This study explored the association between the introduction of a mandatory national target for emergency department (ED) length of stay, which was introduced in New Zealand in 2009, and five key indicators of quality of care. We did this study as there is some evidence from overseas that focusing on a process target for the time spent in the ED may divert attention away from other aspects of quality of care. Our study found that more people left the ED within six hours after introduction of the shorter stays in ED target. There was no difference in the quality of care for patients in pain, with severe infections, with heart attacks, with appendicitis and with fractured hips when comparing the outcomes for these conditions before and after the introduction of the target.

Abstract

Aim

To determine whether implementation of a national health target called Shorter Stays in Emergency Departments impacted on clinical markers of quality of care.

Method

A retrospective pre- and post-intervention study from 2006 to 2012 examined quality of care metrics for five different indicators at different sites in relation to the implementation of the target using a general linear model for times to treatment. Explanatory variables included period (pre- or post-target), ethnicity, age, deprivation and severity of condition. Back transformed least square means were used to describe the outcomes.

Results

The times to treatment for ST elevation myocardial infarction; 36.9 (28–49) vs 47.6 (36–63) minutes p=0.14, antibiotics for severe sepsis; 105.9 (73–153) vs 104.3 (70–155) minutes p=0.93, analgesia for moderate or severe pain; 48 (31–75) vs 46 (32–66) minutes p =0.77, theatre for fractured neck of femur; 35.4 (32.1–39.1) vs 32.4 (29.2–36.1) hours, and to theatre for appendicitis; 14.1 (12–17) vs 16.4 (14–20) hours were unchanged after implementation of the target. Treatment adequacy was also unchanged for these indicators.

Conclusion

Introduction of the Shorter Stays in Emergency Departments target was not associated with any clinically important or statistically significant changes in the time to treatment and adequacy of care for five different clinical indicators of quality of care in Aotearoa New Zealand. For those indicators measured at one site only, it is unknown whether these results can be generalised to other sites.

Author Information

Peter Jones, Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland, Section of Epidemiology and Biostatistics, University of Auckland, Auckland; James Le Fevre, Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland; Alana Harper, Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland; Susan Wells, Section of Epidemiology and Biostatistics, University of Auckland, Auckland; Joanna Stewart, Section of Epidemiology and Biostatistics, University of Auckland, Auckland; Elana Curtis, Te Kupenga Hauora Māori, University of Auckland, Auckland; Papaarangi Reid, Te Kupenga Hauora Māori, University of Auckland, Auckland; Shanthi Ameratunga, Section of Epidemiology and Biostatistics, University of Auckland, Auckland.

Correspondence

Peter G Jones, Director of Emergency Medicine Research, Adult Emergency Department, Auckland City Hospital, Park Road, Grafton, Auckland 1142.

Correspondence Email

peterj@adhb.govt.nz

Competing Interests

During his time as a research fellow on this study, JLF was also an elected member of one district health board. This potential competing interest was declared to all relevant parties prior to commencing the research activities, and his work was supervised directly by the corresponding author (PJ). The relevant parties and all other authors were satisfied that this potential conflict did not influence JLF’s contributions to the submitted work. No other authors have any conflict of interest to declare.

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