Timeliness is important only to the extent that high-quality patient care is preserved
Increasing demand for emergency care has worsened access to acute hospital services across the developed world. Australia’s response has been a mixture of time-based emergency department (ED) targets to drive process improvements, efforts to divert patients from EDs into community-based services and changes to accelerate hospital-wide processes and patient discharges. There has also been increased investment in bed capacity, although not commensurate with rising demand. Seasonal planning has been undertaken for both acute and sub-acute sectors. Despite these initiatives, access to acute hospital care has become measurably worse.1
The full article is accessible to AMA
members and paid subscribers.
Login to MJA or subscribe now.
- 1. Cameron PA, Joseph AP, McCarthy SM. Access block can be managed. Med J Aust 2009; 190: 364-368. <MJA full text>
- 2. Australian Government Department of Health and Ageing. Australian Health Ministers’ Conference joint communiqué 22 April 2010. http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr10-dept-dept220410.htm (accessed Nov 2010).
- 3. Lansley A. Secretary of State for Health, United Kingdom [letter to John Heyworth, President of the College of Emergency Medicine], 21 Jun 2010. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_116917.pdf (accessed Nov 2010).
- 4. Bevan G, Hood C. Have targets improved performance in the English NHS? BMJ 2006; 332: 419-422.
- 5. Blunt I, Bardsley M, Dixon J. Trends in emergency admissions in England 2004–2009: is greater efficiency breeding inefficiency? London: The Nuffield Trust, 2010. http://www.nuffieldtrust.org.uk/publications/detail.aspx?id=145&PRid=714 (accessed Aug 2010).
- 6. Downing A, Wilson R, Cooke M. Which patients spend more than 4 hours in the accident and emergency department? J Public Health 2004; 26: 172-176. http://jpubhealth.oxfordjournals.org/cgi/content/abstract/26/2/172 (accessed Nov 2010).
- 7. Cooke M, Fisher J, Dale J, et al. Reducing attendances and waits in emergency departments. A systematic review of present innovations. Report to the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D. London: NCCSDO, 2004. http://www.sdo.nihr.ac.uk/projdetails.php?ref=08-1204-029 (accessed Aug 2010).
- 8. British Medical Association Health Policy and Economic Research Unit. Emergency medicine. Report of national survey of emergency medicine. Jan 2007. http://www.bma.org.uk/images/Emergencymedicine_tcm26-146692.pdf (accessed Aug 2010).
- 9. The NHS in England. http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx (accessed Aug 2010).
- 10. Francis R. Independent inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005–March 2009. Volume 1. London: The Stationery Office, 2010. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_113447.pdf (accessed Aug 2010).
- 11. Kelman S, Friedman JN. Performance improvement and performance dysfunction: an empirical examination of impacts of the emergency room wait-time target in the English National Health Service. J Public Adm Res Theory 2009; 19: 917-946.
Online responses are no longer available. Please refer to our instructions for authors page for more information.
Peter Cameron was on recent sabbatical in the UK, which was paid for by The Alfred Hospital, Melbourne, examining the ED 4-hour rule. As the UK National Clinical Director for Urgent and Emergency Care, Matthew Cooke is responsible for developing the new indicators mentioned in the article.