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

Roberto Forero, Nicola Man, Sally McCarthy, Drew Richardson, Mohammed Mohsin, Ghasem Sam Toloo, Gerry FitzGerald, Hanh Ngo, David Mountain, Daniel Fatovich, Antonio Celenza, Nick Gibson, Fenglian Xu, Shizar Nahidi, Ken Hillman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the impact of the Australian National Emergency Access Target (NEAT) policy introduced in 2012 on ED performance. METHODS: A longitudinal cohort study of NEAT implementation using linked data, for 12 EDs across New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between 2008 and 2013. Segmented regression in a multi-level model was used to analyse ED performance over time before and after NEAT introduction. The main outcomes measures were ED length of stay ≤4 h, access block, number of ED presentations, short-stay admission (≤24 h), >24 h admissions, unplanned ED re-attendances within 7 days and 'left at own risk' (including 'did not wait for assessment'). RESULTS: Two years after NEAT introduction, ED length of stay ≤4 h increased in NSW and QLD (odds ratio [OR] = 2.48 and 3.24; P < 0.001) and access block decreased (OR = 0.41 and 0.22; P < 0.001), but not in ACT (OR = 1.28; P > 0.05). ED presentations increased over time before and after NEAT introduction with a significant increase above the projected trend in NSW after NEAT (mean ratio = 1.07). Short-stay admissions increased in QLD (OR = 2.60), ACT (OR = 1.68) and NSW (OR = 1.35). Unplanned ED re-attendances did not change significantly. Those who left at their own risk decreased significantly in NSW and QLD (OR = 0.38 and 0.67). CONCLUSION: ED presentations continued to increase over time in all jurisdictions. NSW and QLD, but not ACT, showed significant improvements in time-based measures. Significant increases in short-stay admissions suggest a strategic change in ED process associated with NEAT implementation. Rates of unplanned ED re-attendances and those leaving at their own risk showed no evidence for adverse effects from NEAT.

Original languageEnglish
Pages (from-to)253-261
Number of pages9
JournalEmergency medicine Australasia : EMA
Volume31
Issue number2
DOIs
Publication statusPublished - 1 Apr 2019

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Australian Capital Territory
New South Wales
Queensland
Hospital Emergency Service
Emergencies
Odds Ratio
Length of Stay
Longitudinal Studies
Cohort Studies
Outcome Assessment (Health Care)

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Forero, Roberto ; Man, Nicola ; McCarthy, Sally ; Richardson, Drew ; Mohsin, Mohammed ; Toloo, Ghasem Sam ; FitzGerald, Gerry ; Ngo, Hanh ; Mountain, David ; Fatovich, Daniel ; Celenza, Antonio ; Gibson, Nick ; Xu, Fenglian ; Nahidi, Shizar ; Hillman, Ken. / 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. In: Emergency medicine Australasia : EMA. 2019 ; Vol. 31, No. 2. pp. 253-261.
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abstract = "OBJECTIVE: To evaluate the impact of the Australian National Emergency Access Target (NEAT) policy introduced in 2012 on ED performance. METHODS: A longitudinal cohort study of NEAT implementation using linked data, for 12 EDs across New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between 2008 and 2013. Segmented regression in a multi-level model was used to analyse ED performance over time before and after NEAT introduction. The main outcomes measures were ED length of stay ≤4 h, access block, number of ED presentations, short-stay admission (≤24 h), >24 h admissions, unplanned ED re-attendances within 7 days and 'left at own risk' (including 'did not wait for assessment'). RESULTS: Two years after NEAT introduction, ED length of stay ≤4 h increased in NSW and QLD (odds ratio [OR] = 2.48 and 3.24; P < 0.001) and access block decreased (OR = 0.41 and 0.22; P < 0.001), but not in ACT (OR = 1.28; P > 0.05). ED presentations increased over time before and after NEAT introduction with a significant increase above the projected trend in NSW after NEAT (mean ratio = 1.07). Short-stay admissions increased in QLD (OR = 2.60), ACT (OR = 1.68) and NSW (OR = 1.35). Unplanned ED re-attendances did not change significantly. Those who left at their own risk decreased significantly in NSW and QLD (OR = 0.38 and 0.67). CONCLUSION: ED presentations continued to increase over time in all jurisdictions. NSW and QLD, but not ACT, showed significant improvements in time-based measures. Significant increases in short-stay admissions suggest a strategic change in ED process associated with NEAT implementation. Rates of unplanned ED re-attendances and those leaving at their own risk showed no evidence for adverse effects from NEAT.",
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author = "Roberto Forero and Nicola Man and Sally McCarthy and Drew Richardson and Mohammed Mohsin and Toloo, {Ghasem Sam} and Gerry FitzGerald and Hanh Ngo and David Mountain and Daniel Fatovich and Antonio Celenza and Nick Gibson and Fenglian Xu and Shizar Nahidi and Ken Hillman",
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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. / Forero, Roberto; Man, Nicola; McCarthy, Sally; Richardson, Drew; Mohsin, Mohammed; Toloo, Ghasem Sam; FitzGerald, Gerry; Ngo, Hanh; Mountain, David; Fatovich, Daniel; Celenza, Antonio; Gibson, Nick; Xu, Fenglian; Nahidi, Shizar; Hillman, Ken.

In: Emergency medicine Australasia : EMA, Vol. 31, No. 2, 01.04.2019, p. 253-261.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of the National Emergency Access Target policy on emergency departments' performance

T2 - A time-trend analysis for New South Wales, Australian Capital Territory and Queensland

AU - Forero, Roberto

AU - Man, Nicola

AU - McCarthy, Sally

AU - Richardson, Drew

AU - Mohsin, Mohammed

AU - Toloo, Ghasem Sam

AU - FitzGerald, Gerry

AU - Ngo, Hanh

AU - Mountain, David

AU - Fatovich, Daniel

AU - Celenza, Antonio

AU - Gibson, Nick

AU - Xu, Fenglian

AU - Nahidi, Shizar

AU - Hillman, Ken

PY - 2019/4/1

Y1 - 2019/4/1

N2 - OBJECTIVE: To evaluate the impact of the Australian National Emergency Access Target (NEAT) policy introduced in 2012 on ED performance. METHODS: A longitudinal cohort study of NEAT implementation using linked data, for 12 EDs across New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between 2008 and 2013. Segmented regression in a multi-level model was used to analyse ED performance over time before and after NEAT introduction. The main outcomes measures were ED length of stay ≤4 h, access block, number of ED presentations, short-stay admission (≤24 h), >24 h admissions, unplanned ED re-attendances within 7 days and 'left at own risk' (including 'did not wait for assessment'). RESULTS: Two years after NEAT introduction, ED length of stay ≤4 h increased in NSW and QLD (odds ratio [OR] = 2.48 and 3.24; P < 0.001) and access block decreased (OR = 0.41 and 0.22; P < 0.001), but not in ACT (OR = 1.28; P > 0.05). ED presentations increased over time before and after NEAT introduction with a significant increase above the projected trend in NSW after NEAT (mean ratio = 1.07). Short-stay admissions increased in QLD (OR = 2.60), ACT (OR = 1.68) and NSW (OR = 1.35). Unplanned ED re-attendances did not change significantly. Those who left at their own risk decreased significantly in NSW and QLD (OR = 0.38 and 0.67). CONCLUSION: ED presentations continued to increase over time in all jurisdictions. NSW and QLD, but not ACT, showed significant improvements in time-based measures. Significant increases in short-stay admissions suggest a strategic change in ED process associated with NEAT implementation. Rates of unplanned ED re-attendances and those leaving at their own risk showed no evidence for adverse effects from NEAT.

AB - OBJECTIVE: To evaluate the impact of the Australian National Emergency Access Target (NEAT) policy introduced in 2012 on ED performance. METHODS: A longitudinal cohort study of NEAT implementation using linked data, for 12 EDs across New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between 2008 and 2013. Segmented regression in a multi-level model was used to analyse ED performance over time before and after NEAT introduction. The main outcomes measures were ED length of stay ≤4 h, access block, number of ED presentations, short-stay admission (≤24 h), >24 h admissions, unplanned ED re-attendances within 7 days and 'left at own risk' (including 'did not wait for assessment'). RESULTS: Two years after NEAT introduction, ED length of stay ≤4 h increased in NSW and QLD (odds ratio [OR] = 2.48 and 3.24; P < 0.001) and access block decreased (OR = 0.41 and 0.22; P < 0.001), but not in ACT (OR = 1.28; P > 0.05). ED presentations increased over time before and after NEAT introduction with a significant increase above the projected trend in NSW after NEAT (mean ratio = 1.07). Short-stay admissions increased in QLD (OR = 2.60), ACT (OR = 1.68) and NSW (OR = 1.35). Unplanned ED re-attendances did not change significantly. Those who left at their own risk decreased significantly in NSW and QLD (OR = 0.38 and 0.67). CONCLUSION: ED presentations continued to increase over time in all jurisdictions. NSW and QLD, but not ACT, showed significant improvements in time-based measures. Significant increases in short-stay admissions suggest a strategic change in ED process associated with NEAT implementation. Rates of unplanned ED re-attendances and those leaving at their own risk showed no evidence for adverse effects from NEAT.

KW - ACT

KW - National Emergency Access Target

KW - NSW

KW - QLD

KW - trend analysis

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DO - 10.1111/1742-6723.13142

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JO - Emergency Medicine

JF - Emergency Medicine

SN - 1742-6723

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