New Zealand's emergency department target - did it reduce ED length of stay, and if so, how and when?

Show simple item record Tenbensel, Timothy en Chalmers, Linda en Jones, Peter en Appleton-Dyer, Sarah en Walton, Lisa en Ameratunga, Shanthi en 2018-11-13T03:16:47Z en 2017-09-26 en
dc.identifier.citation BMC Health Services Research 17(678):15 pages 26 Sep 2017 en
dc.identifier.issn 1472-6963 en
dc.identifier.uri en
dc.description.abstract In 2009, the New Zealand government introduced a hospital emergency department (ED) target - 95% of patients seen, treated or discharged within 6 h - in order to alleviate crowding in public hospital EDs. While these targets were largely met by 2012, research suggests that such targets can be met without corresponding overall reductions in ED length-of-stay (LOS). Our research explores whether the NZ ED time target actually reduced ED LOS, and if so, how and when.We adopted a mixed-methods approach with integration of data sources. After selecting four hospitals as case study sites, we collected all ED utilisation data for the period 2006 to 2012. ED LOS data was derived in two forms-reported ED LOS, and total ED LOS - which included time spent in short-stay units. This data was used to identify changes in the length of ED stay, and describe the timing of these changes to these indicators. Sixty-eight semi-structured interviews and two surveys of hospital clinicians and managers were conducted between 2011 and 2013. This data was then explored to identify factors that could account for ED LOS changes and their timing.Reported ED LOS reduced in all sites after the introduction of the target, and continued to reduce in 2011 and 2012. However, total ED LOS only decreased from 2008 to 2010, and did not reduce further in any hospital. Increased use of short-stay units largely accounted for these differences. Interview and survey data showed changes to improve patient flow were introduced in the early implementation period, whereas increased ED resources, better information systems to monitor target performance, and leadership and social marketing strategies mainly took throughout 2011 and 2012 when total ED LOS was not reducing.While the ED target clearly stimulated improvements in patient flow, our analysis also questions the value of ED targets as a long term approach. Increased use of short-stay units suggests that the target became less effective in 'standing for' improved timeliness of hospital care in response to increasing acute demand. As such, the overall challenges in managing demand for acute and urgent care in New Zealand hospitals remain. en
dc.format.medium Electronic en
dc.language eng en
dc.relation.ispartofseries BMC health services research en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri en
dc.rights.uri en
dc.subject Humans en
dc.subject Length of Stay en
dc.subject Patient Discharge en
dc.subject Communication en
dc.subject Leadership en
dc.subject Emergency Service, Hospital en
dc.subject New Zealand en
dc.subject Interviews as Topic en
dc.title New Zealand's emergency department target - did it reduce ED length of stay, and if so, how and when? en
dc.type Journal Article en
dc.identifier.doi 10.1186/s12913-017-2617-1 en
pubs.issue 1 en
pubs.begin-page 678 en
pubs.volume 17 en
dc.rights.holder Copyright: The authors en
dc.identifier.pmid 28950856 en
pubs.publication-status Published en
dc.rights.accessrights en
pubs.subtype research-article en
pubs.subtype Journal Article en
pubs.elements-id 677469 en Medical and Health Sciences en Population Health en Epidemiology & Biostatistics en Health Systems en School of Medicine en Surgery Department en
dc.identifier.eissn 1472-6963 en
pubs.record-created-at-source-date 2017-09-28 en
pubs.dimensions-id 28950856 en

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