Volume 191 - Issue 6
Pathology processes and emergency department length of stay: the impact of change
Authors: Andrew J Francis, Michael J Ray and Mary C Marshall
Med J Aust 2009; 191 (6): 359. || doi: 10.5694/j.1326-5377.2009.tb02834.x
Published online: 21 September 2009
Published online: 21 September 2009
In reply: A recent report on the state of Australian public hospitals highlights figures of 320.6 emergency presentations per 1000 weighted population, with 88% of presentations being triage categories 1–4, and 66% of patients not admitted.1 In our experience, pathology tests are performed on more than 50% of patients in these triage categories who present to emergency departments, and decisions regarding patient care are delayed pending availability of test results. In addition to the initiatives that we described,2 Georgiou and Westbrook describe other initiatives that deliver significant, sustained improvements in health care efficiency.
Many have emphasised the need to improve efficiency in the health care system by utilising evidence-based best practice. However, a recently published discussion paper highlights the challenges associated with ensuring that health care workers have access to, and actually use, evidence-based processes and protocols that have been shown to benefit patients.3 Similarly, delays in care may contribute to patient harm, and decisions about resource allocation and organisational systems do not always explicitly take this risk into consideration.3
These challenges may be partly related to the different funding arrangements in the Australian health care system. Apart from the obvious federal–state dichotomy, diagnostics, such as pathology services, and the associated information technology are often funded separately to the hospitals and health care professionals relying on these services. As a result, one of the challenges of implementing initiatives that improve efficiency relates to current and historical allocative funding arrangements, where costs may be borne by one cost centre, and benefits are delivered to patients and other elements of the health care system (ie, other health care providers and departments).
It is essential that the Productivity Commission4 considers all of these elements in its review to identify significant efficiency improvements within the hospital system. Effectiveness, allocative efficiency and dynamic efficiency are just as important as simple economic efficiency. Unnecessary delays in the health care system are not only associated with capital costs — they are also associated with an array of direct and indirect costs related to caring for patients who endure an unnecessarily protracted journey through the health care system.
It will take courage and commitment to implement and achieve appropriate use of evidence-based care (perhaps via mandates3) and appropriately fund all elements of patient care, so that improvements in care and overall cost savings are not hindered by historical funding constraints.
References
- Australian Government Department of Health and Ageing. The state of our public hospitals: June 2009 report. Canberra: Commonwealth of Australia, 2009. http://www.health.gov.au/internet/main/publishing.nsf/Content/1186FF4200B2B2E6CA257 5D9000F73B8/$File/SoOPH%202009.pdf (accessed Jul 2009).
- Francis AJ, Ray MJ, Marshall MC. Pathology processes and emergency department length of stay: the impact of change. Med J Aust 2009; 190: 665-669. 0_CBBJBJIA
- Australian Commission on Safety and Quality in Health Care. Discussion paper on achieving the directions established in the proposed National Safety and Quality Framework. Sydney: ACSQHC, 2009. http://www.qualityhealthcareconversation.org.au/uploads/36707/ufiles/downloads/discussion-paper-on-safety-and-quality-framework.pdf (accessed Jul 2009).
- Australian Government Productivity Commission. Performance of public and private hospital systems: Productivity Commission issues paper. Melbourne: Productivity Commission, 2009. http://www.pc.gov.au/__data/assets/pdf_file/0004/89959/issues-paper.pdf (accessed Jul 2009).