Review article: Have emergency department time-based targets influenced patient care? A systematic review of qualitative literature

Katie Walker; Bridget Honan; Daniel Haustead; David Mountain; Vinay Gangathimmaiah; Roberto Forero; Rob Mitchell; Ella Martini; Greg Tesch; Ian Bissett; Peter Jones

doi:10.1111/1742-6723.13747

Review article: Have emergency department time-based targets influenced patient care? A systematic review of qualitative literature

Emerg Med Australas. 2021 Apr;33(2):202-213. doi: 10.1111/1742-6723.13747. Epub 2021 Feb 23.

Authors

Katie Walker^{1

2}, Bridget Honan³, Daniel Haustead⁴, David Mountain⁵, Vinay Gangathimmaiah⁶, Roberto Forero⁷, Rob Mitchell⁸, Ella Martini⁹, Greg Tesch¹⁰, Ian Bissett¹¹, Peter Jones¹²

Affiliations

¹ Emergency Department, Cabrini Institute, Melbourne, Victoria, Australia.
² School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
³ Central Australian Retrieval Service, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
⁴ Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
⁵ Emergency Department, Sir Charles Gardner Hospital, Perth, Western Australia, Australia.
⁶ Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.
⁷ South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
⁸ Emergency Department, Alfred Hospital, Melbourne, Victoria, Australia.
⁹ Melbourne, Victoria, Australia.
¹⁰ Nephrology Department, Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
¹¹ Department of Surgery, The University of Auckland, Auckland, New Zealand.
¹² School of Medicine, The University of Auckland, Auckland, New Zealand.

PMID: 33622021
DOI: 10.1111/1742-6723.13747

Abstract

Time-based targets for ED length of stay were introduced in England in 2000, followed by the rest of the UK, Canada, Ireland, New Zealand, and Australia after ED crowding was associated with poor quality of care and increased mortality. This systematic review evaluates qualitative literature to see if ED time-based targets have influenced patient care quality. We included 13 studies from four countries, incorporating 617 interviews. We conclude that time-based targets have impacted on the quality of emergency patient care, both positively and negatively. Successful implementation depends on whole hospital resourcing and engagement with targets.

Keywords: delivery of healthcare; healthcare quality, access and evaluation; healthcare systems; medicine, emergency; qualitative research; review, systematic.

Publication types

Review
Systematic Review

MeSH terms

Crowding
Emergency Medical Services*
Emergency Service, Hospital*
Humans
Length of Stay
Quality of Health Care