Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Use of medical emergency call data as a marker of quality of emergency department care in the post-National Emergency Access Target era

Lorraine Westacott A D , Judy Graves B , Mohsina Khatun C and John Burke B
+ Author Affiliations
- Author Affiliations

A Metro South Addictions and Mental Health Services, Building 23, Garden City Office Park, 2404 Logan Rd, Eight Mile Plains, Qld 4113, Australia.

B Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Qld 4029, Australia. Email: judy.graves@health.qld.gov.au; john.burke@health.qld.gov.au

C Patient Safety and Quality Improvement Service, Department of Health, 15 Butterfield Street, Herston, Qld 4006, Australia. Email: mohsina.khatun@health.qld.gov.au

D Corresponding author. Email: lorraine.westacott@health.qld.gov.au

Australian Health Review - https://doi.org/10.1071/AH17089
Submitted: 23 March 2017  Accepted: 28 September 2017   Published online: 14 November 2017

Abstract

Objectives Any new model of care should always be accompanied by rigorous monitoring to ensure that there are no negative consequences, especially any that impact upon patient safety. In 2013, ‘THERMoSTAT’ (Two- Hour Evaluation and Referral Model for Shorter Turnaround Times), an emergency department model of care developed by Royal Brisbane and Women’s Hospital staff was launched to gain efficiencies and improve hospital National Emergency Access Target (NEAT) compliance. The aim of this study was to trial the use of medical emergency call data as a novel marker of the quality of care delivered by our emergency department.

Methods Incidence of medical emergency calls for hospital emergency admission patients for the 2 years pre- and 1 year post-THERMoSTAT were compared after standardising for overall hospital activity.

Results During the study period, hospital activity increased 10%, and the emergency department experienced a total of 222 645 presentations, 68 000 (30.5%) of which converted into an admission. THERMoSTAT improved NEAT compliance by 17% (from 57.7% to 74.9%) with no change in any patient-safety indicators. A total of 8432 medical emergency calls were made on 5930 patients, 2831 of whom were emergency admissions. After adjusting for hospital activity, there was no change in the average number of patients per week who triggered a medical emergency call after the introduction of THERMoSTAT. These results were reproduced when data was analysed for: total number of inpatients triggering calls; emergency admission patients; and emergency admission patients within the first 24 h or first 4 h of admission.

Conclusions This is the first report to investigate the correlation between inpatient medical emergency call incidence and emergency department model of care. Medical emergency call data showed significant promise as a measure of morbidity and as a more direct, objective, simple, quantitative and meaningful measure of patient safety.

What is known about the topic? It is well established that extended emergency department lengths of stay are associated with poorer patient outcomes. The corollary of this is not always true however; shorter emergency department length of stay does not automatically translate into better care. Although the underlying philosophy of NEAT is to enhance patient care, there is a risk of negative consequences if NEAT is seen as an end in itself. Many of the commonly used emergency department key performance indicators focus on the timeliness of care and there is a scarcity of easily quantifiable markers that reliably reflect the quality of that care.

What does this paper add? This study builds on the concept of medical emergency call incidence as a marker of safety and quality. It explores the utility of using the number of medical emergency calls made in the first few hours of an emergency admission as an indicator of the quality of care delivered by the emergency department. This is significant because it introduces a measure that has a focus that embraces more than the timeliness of care only.

What are the implications for practitioners? If medical emergency call incidence in early emergency admissions can be proven to accurately reflect emergency department quality of care then it would provide an easily monitored, objective, quantitative and prompt measure that evaluates dimensions other than timeliness.


References

[1]  Burke J, Greenslade J, Chabrowska J, Greenslade K, Jones S, Montana J, Bell A, O’Connor A. Two-hour evaluation and referral model for shorter turnaround times in the emergency department. Emerg Med Australas 2017; 29 315–23.
Two-hour evaluation and referral model for shorter turnaround times in the emergency department.CrossRef |

[2]  Government of Western Australia, Department of Health. Taking pressure off public hospitals 2008 – 2013. Perth: Department of Health; 2009. Available at: http://www.federalfinancialrelations.gov.au/content/npa/health/national-partnership/past/Taking-the-pressure-off-public-hospitals-NP-WA_IP.pdf [verified 27 January 2017].

[3]  Ministry of Health. Health targets 2009/10. Wellington: Ministry of Health; 2009. Available at: https://www.health.govt.nz/system/files/documents/publications/health-targets-0910-nov09-v3.pdf [verified 27 January 2017].

[4]  Ministry of Health. Targeting emergencies: shorter stays in emergency departments. Wellington: Ministry of Health; 2011. Available at: http://www.health.govt.nz/publication/targeting-emergencies-shorter-stays-emergency-departments [verified 27 January 2017].

[5]  Working Party for the Royal College of Surgeons of England. Emergency department: medicine and surgery interface problems and solutions. London: The Royal College of Surgeons of England; 2004. Available at: www.stemlyns.org.uk/download.php?dtType=library&fileID=13 [verified 22 December 2016].

[6]  Geelhoed G, de Klerk N. Emergency department overcrowding, mortality and the 4-hour rule in Western Australia. Med J Aust 2012; 196 122–6.
Emergency department overcrowding, mortality and the 4-hour rule in Western Australia.CrossRef |

[7]  Maumill L, Zic M, Esson A, Geelhoed GC, Borland MM, Johnson C, Aylward P, Martin AC. The National Emergency Access Target (NEAT): can quality go with timeliness? Med J Aust 2013; 198 153–7.
The National Emergency Access Target (NEAT): can quality go with timeliness?CrossRef |

[8]  Australian Government Department of Health and Aging (DoHA). The national partnership agreement on improving public hospital services. Canberra: DoHA; 2010. Available at: http://www.federalfinancialrelations.gov.au/content/npa/health/_archive/national-workforce-reform/national_partnership.pdf [verified 6 February 2017].

[9]  Forero R, McDonnell GD, McCarthy SM, Nugus P, Braithwaite J, Hillman KM, Fatovich DM, Mountain D, Daly FF, Fitzgerald GJ, Richardson DB. Lessons from the four-hour rule standard in England for Australia. Med J Aust 2011; 194 268

[10]  Perera ML, Davies AW, Gnaneswaran N, Giles M, Liew D, Ritchie P, Chan ST. Clearing emergency departments and clogging wards: National Emergency Access Target and the law of unintended consequences. Emerg Med Australas 2014; 26 549–55.
Clearing emergency departments and clogging wards: National Emergency Access Target and the law of unintended consequences.CrossRef |

[11]  Nash L, Tacey M, Liew D, Jones C, Truesdale M, Russell D. Impact of emergency access targets on admissions to general medicine: a retrospective cohort study. Intern Med J 2013; 43 1110–6.
Impact of emergency access targets on admissions to general medicine: a retrospective cohort study.CrossRef | 1:STN:280:DC%2BC3sfptlWrtA%3D%3D&md5=448bb920ac18fcb2bd579f3c79f6c847CAS |

[12]  United Kingdom Department of Health/National Health Service. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. 2013. Available at: http://www.midstaffspublicinquiry.com/report [verified 27 January 2017] .

[13]  Mason S, Weber EJ, Coster J, Freeman J, Locker T. Time patients spend in the emergency department: England’s 4-hour rule – a case of hitting the target but missing the point? Ann Emerg Med 2012; 59 341–9.
Time patients spend in the emergency department: England’s 4-hour rule – a case of hitting the target but missing the point?CrossRef |

[14]  Sullivan C, Staib A, Khanna S, Good NM, Boyle J, Cattell R, Heiniger L, Griffin BR, Bell AJ, Lind J, Scott IA. The National Emergency Access Target (NEAT) and the 4-hour rule: time to review the target. Med J Aust 2016; 204 354
The National Emergency Access Target (NEAT) and the 4-hour rule: time to review the target.CrossRef |

[15]  Commission for Healthcare Audit and Inspection. Investigation into Mid Staffordshire NHS Foundation Trust. London: Healthcare Commission; 2009. Available at: http://webarchive.nationalarchives.gov.uk/20110504135228/http://www.cqc.org.uk/_db/_documents/Investigation_into_Mid_Staffordshire_NHS_Foundation_Trust.pdf [verified 22 December 2016].

[16]  Lilford R, Pronovost P. Using hospital mortality rates to judge hospital performance: a bad idea that just won’t go away. BMJ 2010; 340 c2016
Using hospital mortality rates to judge hospital performance: a bad idea that just won’t go away.CrossRef |

[17]  Jarman B, Gault S, Alves B, Hider A, Dolan S, Cook A, Hurwitz B, Iezzoni LI. Explaining differences in English hospital death rates using routinely collected data. BMJ 1999; 318 1515–20.
Explaining differences in English hospital death rates using routinely collected data.CrossRef | 1:STN:280:DyaK1M3osVGktA%3D%3D&md5=f846125709c4e219e7af957fc6326737CAS |

[18]  van Gestel YR, Lemmens VE, Lingsma HF, de Hingh IH, Rutten HJ, Coebergh JW. the hospital standardized mortality ratio fallacy: a narrative review. Med Care 2012; 50 662–7.
the hospital standardized mortality ratio fallacy: a narrative review.CrossRef |

[19]  Scobie S, Thomson R, McNeil JJ, Phillips PA. Measurement of the safety and quality of health care. Med J Aust 2006; 184 S51

[20]  Saver BG, Martin SA, Adler RN, Candib LM, Deligiannidis KE, Golding J, Mullin DJ, Roberts M, Topolski S. Care that matters: quality measurement and health care. PLoS Med 2015; 12 e1001902
Care that matters: quality measurement and health care.CrossRef |

[21]  Richardson D. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust 2006; 184 213–6.

[22]  Sprivulis PC, Da Silva JA, Jacobs IG, Frazer AR, Jelinek GA. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust 2006; 184 208–12.

[23]  Forero R, Hillman KM, McCarthy S, Fatovich DM, Joseph AP, Richardson DB. Access block and ED overcrowding. Emerg Med Australas 2010; 22 119–35.
Access block and ED overcrowding.CrossRef |

[24]  The Royal Australasian College of Physicians Submission. COAG panel inquiry: national elective surgery targets, the national access guarantee, and emergency department targets. Canberra: Australian Government; 2011. Available at: https://www.racp.edu.au/docs/default-source/advocacy-library/submission-to-coag-inquiry-hospital-access-targets.pdf [verified 22 December 2016].

[25]  Locker T, Mason S. Digit preference bias in the recording of emergency department times. Eur J Emerg Med 2006; 13 99–101.
Digit preference bias in the recording of emergency department times.CrossRef |

[26]  Jones P, Schimanski K. The four-hour target to reduce emergency department ‘waiting time’: a systematic review of clinical outcomes. Emerg Med Australas 2010; 22 391–8.
The four-hour target to reduce emergency department ‘waiting time’: a systematic review of clinical outcomes.CrossRef |

[27]  Khalifa M, Zabani I. developing emergency room key performance indicators: what to measure and why should we measure it? Stud Health Technol Inform 2016; 226 179–82.

[28]  Madsen MM, Eiset AH, Mackenhauer J, Odby A, Christiansen CF, Kurland L, Kirkegaard H. Selection of quality indicators for hospital-based emergency care in Denmark, informed by a modified-Delphi process. Scand J Trauma Resusc Emerg Med 2016; 24 11
Selection of quality indicators for hospital-based emergency care in Denmark, informed by a modified-Delphi process.CrossRef |

[29]  United Kingdom Department of Health. A&E clinical quality indicators implementation guidance. London: United Kingdom Department of Health; 2010. Available at: http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_123055.pdf [verified 6 February 2017].

[30]  Jones D, Bellomo R, DeVita M. Effectiveness of the medical emergency team: the importance of dose. Crit Care 2009; 13 313
Effectiveness of the medical emergency team: the importance of dose.CrossRef |

[31]  Considine J, Jones D, Pilcher D, Currey J. Physiological status during emergency department care: relationship with in-hospital death after clinical deterioration. Crit Care Resusc 2015; 17 257–62.

[32]  Burch VC, Tarr G, Morroni C. Modified early warning score predicts the need for hospital admission and in-hospital mortality. Emerg Med J 2008; 25 674–8.
Modified early warning score predicts the need for hospital admission and in-hospital mortality.CrossRef | 1:STN:280:DC%2BD1cnltVejtQ%3D%3D&md5=dacd98cc2443b791ea146d15bff59936CAS |

[33]  Lewis Hunter AE, Spatz ES, Bernstein SL, Rosenthal MS. Factors influencing hospital admission of non-critically ill patients presenting to the emergency department: a cross-sectional study. J Gen Intern Med 2016; 31 37–44.
Factors influencing hospital admission of non-critically ill patients presenting to the emergency department: a cross-sectional study.CrossRef |

[34]  Considine J, Lucas E, Wunderlich B. The uptake of an early warning system in one Australian emergency department: a pilot study. Crit Care Resusc 2012; 14 135–41.

[35]  Hosking J, Considine J, Sands N. Recognising clinical deterioration in emergency department patients. Australas Emerg Nurs J 2014; 17 59–67.
Recognising clinical deterioration in emergency department patients.CrossRef |

[36]  Considine J, Rawet J, Currey J. The effect of a staged, emergency department specific, rapid response system on reporting of clinical deterioration. Australas Emerg Nurs J 2015; 18 218–26.
The effect of a staged, emergency department specific, rapid response system on reporting of clinical deterioration.CrossRef |



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