Faster emergency departments haven't impacted care - study

Auckland CIty Hospital (James Fyfe/Newshub.)
Auckland CIty Hospital (James Fyfe/Newshub.)

Emergency departments are getting patients out the door faster than they used to, but many are not getting treated any more quickly, a new study has found.

The Ministry of Health's 'Shorter Stays in Emergency Departments' targets, introduced in 2009, aimed to have 95 percent of patients presenting at an emergency department (ED) admitted, discharged, or transferred within six hours.

At the time, the national average was about 80 percent. By 2016 that had improved to 93 percent, with the result being a 27 percent reduction in ED overcrowding and a "significant decrease" in ED patient mortality rates, according to the Ministry of Health.

Peter Jones, director of emergency medicine research at Auckland City Hospital and a member of the Shorter Stays in Emergency Department National Research Project, looked at data before the Shorter Stays programme was introduced (2006) and after (2012).  

How long it took ED staff to administer treatment for severe sepsis, a heart attack or moderate to severe pain, or get patients suffering from appendicitis or a fractured neck into the operating theatre, was unchanged. Changes to the quality of treatment patients presenting with one of those five conditions was also statistically insignificant.

Dr Jones concluded the Shorter Stays programme "was not associated with any clinically important or statistically significant changes in the time to treatment and adequacy of care for five different clinical indicators of quality of care".

But that doesn't mean it's been a waste of time. Overall, the research shows "more efficient care overall in EDs without altering outcomes for the conditions we studied".

"When the target was introduced, no one knew what effect it would have - beneficial or harmful - which is why we did the research," said Dr Jones.

"The main outcomes of our broader study show a reduction in deaths in ED in association with the target, along with other mainly positive outcomes."

Dr Jones' ongoing research into the Shorter Stays programme found improving efficiency of EDs saved around 700 lives between 2009 and 2012, even if for some conditions, there was little effect on the speed and quality of treatment.

"It is possible to regard this as either a success - no adverse effect demonstrated - or a failure - no improvement demonstrated - depending on your point of view," said Dr Jones. "As care was pretty good beforehand for the particular outcomes we've looked at here, it is harder to show a benefit."

The Ministry of Health told Newshub EDs have improved their systems since 2012, "when the health target was still reasonably new and DHBs were still embedding their improvement activities". Although the targets had only been in place three years when the data snapshot was taken, other positives were also starting to be seen.

"The target also led to a reduction in patients' in-hospital length of stay by an average of seven hours, and an increase in available beds, creating capacity for more acute admissions," said the ministry.

Previous research released by the National Research Project found there was no change to the speed of treatment for acute asthma patients, but more of them received treatment overall. 

The latest findings were published on Friday in the New Zealand Medical Journal.