Aiming to be NEAT: safely improving and sustaining access to emergency care in a tertiary referral hospital.

摘要: Objective To implement and evaluate strategies for improving access to emergency department (ED) care in a tertiary hospital. Methods A retrospective pre–post intervention study using routinely collected data involving all patients presenting acutely the ED of major hospital over 2-year period. Main outcome measures were changes in: percentage exiting (all patients, discharged directly from ED, admitted inpatient wards); mean patient transit times ED; mortality rates; rates ‘did not wait’ re-presentations within 48 h discharge; selected safety indicators. Qualitative on staff perceptions interventions also gathered. Results Working groups focused internal processes, ED–inpatient unit interface, hospital-wide discharge processes performance monitoring feedback. Twenty-five different reforms enacted 9-month period April December 2012. Comparing baseline (January–March 2012) with post-reform 2013), 4 h rose (from 32% 62%), 41% 75%) 12% 32%; P < 0.001 comparisons). The (±s.d.) time spent was reduced 7.2 ± 5.8 4.4 ± 3.5 h (P < 0.001) and, associated in-hospital 2.3% 1.7%; P = 0.045). fell 6.9% 1.9% (P < 0.001), whereas among slightly 3.1% 3.8%; P = 0.023). Improvements maintained subsequent 12 months. Conclusions Multiple targeting both its interface units greatly improved months decreased mortality. What is known about this topic? Prolonged stays result overcrowding, delayed ambulance increased adverse outcomes patients. introduction Australia National Emergency Access Targets (NEAT), which stipulate at least 70% must exit 4 h, have spurred hospitals into implementing wide range varying levels success achieving such targets. does paper add? This demonstrates how multiple implemented poor performing caused proportion double 9 reach comparable best peer hospitals. 26% reduction no clinically significant effects. It importance robust governance structures, executive sponsorship, cross-disciplinary collaboration, regular feedback NEAT redesign existing clinical work practices bed management operations. are implications clinicians managers? Improving should be regarded as problem located resolved without ED. requires whole-of-hospital solution interdisciplinary collaboration change culture practice relating their