Effect of the Shorter Stays in Emergency Departments time target policy on key indicators of quality of care

Abstract

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