Jones P

Haustead D

Walker K

Honan B

Gangathimmaiah V

Mitchell R

Bissett I

Forero R

Martini E

Mountain D

2021-03-16

Time-based targets (TBTs) for ED stays were introduced to improve quality of care but criticised as having harmful unintended consequences. The aim of the review was to determine whether implementation of TBTs influenced quality of care. Structured searches in medical databases were undertaken (2000-2019). Studies describing a state, regional or national TBTs that reported processes or outcomes of care related to the target were included. Harvest plots were used to summarise the evidence. Thirty-three studies (n = 34 million) were included. In some settings, reductions in mortality were seen in ED, in hospital and at 30 days, while in other settings mortality was unchanged. Mortality reductions were seen in the face of increasing age and acuity of presentations, when short-stay admissions were excluded, and when pre-target temporal trends were accounted for. ED crowding, time to assessment and admission times reduced. Fewer patients left prior to completing their care and fewer patients re-presented to EDs. Short-stay admissions and re-admissions to wards within 30 days increased. There was conflicting evidence regarding hospital occupancy and ward medical emergency calls, while times to treatment for individual conditions did not change. The evidence for associations was mostly low certainty and confidence in the findings is accordingly low. Quality of care generally improved after targets were introduced and when compliance with targets was high. This depended on how targets were implemented at individual sites or within jurisdictions, with important implications for policy makers, health managers and clinicians.

Department of Surgery, The University of Auckland, Auckland, New Zealand.

Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Emergency Department, Cabrini Health, Melbourne, Victoria, Australia.

Central Australian Retrieval Service, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.

Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.

Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia.

Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.

Melbourne, Victoria, Australia.

Emergency Department, Sir Charles Gardner Hospital, Perth, Western Australia, Australia.

© 2021 Australasian College for Emergency Medicine.

Emerg Med Australas. 2021 Mar 16. doi: 10.1111/1742-6723.13760.

0000-0003-1560-1186

0000-0002-5313-5852

0000-0003-0984-9708

0000-0002-6422-3348

0000-0001-6031-6590

0000-0002-6552-4855

https://pubmed.ncbi.nlm.nih.gov/33724685/?otool=iaurydwlib

https://hdl.handle.net/10137/11715

Review article: Has the implementation of time-based targets for emergency department length of stay influenced the quality of care for patients? A systematic review of quantitative literature.

Journal Article

Review

Publication