New research on emergency department performance
Focus on shorter wait times may put people at risk
5 February 2020
New research from the Australian Institute of Health Innovation, Macquarie University, has found that judging the performance of a hospital emergency department (ED) predominantly on how fast it can see people could put patients at risk.
Lead researcher, Dr Robyn Clay-Williams said Australian hospitals are publicly under pressure by government to move patients though EDs faster and are in danger of emphasising speed over safety.
The Australia-first research, published in the International Journal for Quality in Health Care, has shown that proven policies and procedures that keep patients safe in EDs may result in slightly longer wait times and lengths of stay for patients which is at odds with the government’s focus on time measures.
Dr Clay-Williams warned:
Strategies designed to keep patients safe are essential as one in ten people are harmed in hospital. Focusing on speed alone, risks punishing emergency departments that also value adherence to patient safety measures.
“While everyone deserves to be seen promptly when they come to ED, hospital staff should also be supported to provide care in line with best practice guidelines, delivered in a respectful environment,” Dr Clay-Williams said.
Safety measures range from ensuring patients are given an identification bracelet, to appropriate reporting and investigation of poor instances of patient care.
Each state and territory has implemented hospital emergency department targets to ensure that patients are seen promptly and leave the ED for admission, referral or discharge home within 4 hours.
“
This focus on making sure people move into and out of ED quickly can also be at the expense of supporting excellent clinical leadership and teamwork. Our research reinforces the importance of all these factors when assessing if an ED is providing a good service or not,” Dr Clay-Williams states.
The research showed that when the teamwork culture of an ED improved (aspects such as communication and collaboration between doctors and nurses), wait times decreased but length of stay increased. This seems to indicate that where teams are working well together, they are more able to see people arriving at ED quickly but then spend more time assessing and treating patients once they are admitted to the ED.
Additionally, when an ED has high adherence to safety measures, such as following guidelines and other safety strategies, then wait times and length of stay both decrease significantly.
At the hospital level, better implementation of quality management structures, such as good governance and management support, resulted in shorter wait times and lengths of stay in the ED. Dr Clay-Williams said research has also shown that when hospital executives do not value quality and safety strategies, then the underlying message to the ED is that this shouldn’t be their priority either. Tasks are at risk of being performed with time in mind, rather than quality of care.
The ‘Deepening our Understanding of Quality in Australia’ (DUQuA) study is a long-term Australia-wide, multilevel, multi-million-dollar cross-sectional study exploring how quality management systems, leadership and culture in Australian hospitals are related to care delivery and patient outcomes. The study included 32 large hospitals from NSW, Queensland, Victoria, South Australia, Tasmania, The Australian Capital Territory and the Northern Territory.
To find out more, please visit our website: www.mq.edu.au/research/duqua
CENTRES RELATED TO THIS NEWS
Centre for Healthcare Resilience and Implementation Science
FOR FURTHER INFORMATION, PLEASE CONTACT
Chrissy Clay, Research Outreach Coordinator