Affordable Access

deepdyve-link
Publisher Website

When a health policy cuts both ways: Impact of the National Emergency Access Target policy on staff and emergency department performance.

Authors
  • Forero, Roberto1, 2
  • Man, Nicola1, 3
  • Nahidi, Shizar1, 2, 4
  • Fitzgerald, Gerard5
  • Fatovich, Daniel6, 7, 8
  • Mohsin, Mohammed9, 10
  • Ngo, Hanh6
  • Toloo, Ghasem Sam5
  • Gibson, Nick11
  • McCarthy, Sally12, 13
  • Mountain, David6, 14
  • Hillman, Ken1, 2
  • 1 Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia. , (Australia)
  • 2 Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia. , (Australia)
  • 3 School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia. , (Australia)
  • 4 Susan Wakil School of Nursing and Midwifery, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia. , (Australia)
  • 5 School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia. , (Australia)
  • 6 Division of Emergency Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia. , (Australia)
  • 7 Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia. , (Australia)
  • 8 Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia. , (Australia)
  • 9 Psychiatry Research and Teaching Unit, Liverpool Hospital, New South Wales Health, Sydney, New South Wales, Australia. , (Australia)
  • 10 School of Psychiatry, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. , (Australia)
  • 11 School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia. , (Australia)
  • 12 Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia. , (Australia)
  • 13 Emergency Department, Prince of Wales Hospital, Sydney, New South Wales, Australia. , (Australia)
  • 14 Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. , (Australia)
Type
Published Article
Journal
Emergency medicine Australasia : EMA
Publication Date
Apr 01, 2020
Volume
32
Issue
2
Pages
228–239
Identifiers
DOI: 10.1111/1742-6723.13395
PMID: 31595671
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To explore the impact of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) on staff and ED performance. A mixed-methods study design was used to link performance data from 16 participating hospitals with the experiences reported by 119 ED staff during policy implementation. Quantitative and qualitative measures were triangulated to identify the staff and organisational effects on hospital performance. An overall score was developed to categorise hospitals into: high, moderate and low performers, then compared with four qualitative themes: social factors, ED management, ED outcomes and 4HR/NEAT compliance. Key factors identified were stress and morale; intergroup dynamics; interaction with patients; resource management; education and training; financial incentives; impact on quality and safety; perceived improvements on access block and overcrowding. High performing hospitals reported increased stress and decreased morale, decreased staff-patient communication and staff shortages; significant changes in ED management and effective use of the whole-of-hospital approach. Moderate performing hospitals reported similar characteristics to a lesser degree, and the perception that 4HR/NEAT did not impact ED practice. Low performing hospitals also reported increased stress and low morale and a less effective whole-of-hospital approach. ED staff also reported a reduction in communication with patients. There was strong evidence of an association between high stress and low morale and the implementation of the 4HR/NEAT across all levels of performance. These adverse consequences of the 4HR/NEAT implementation indicate that a more nuanced approach to efficiency improvements is required. This would balance processes measured by 4HR/NEAT against a range of other clinical and organisational performance measures. © 2019 Australasian College for Emergency Medicine.

Report this publication

Statistics

Seen <100 times