Targets and the emergency medical system – intended and unintended consequences

Hdl Handle:
http://hdl.handle.net/10147/321680
Title:
Targets and the emergency medical system – intended and unintended consequences
Authors:
Conway, Richard; O’Riordan, Deirdre; Silke, Bernard
Citation:
Conway R, O'Riordan D, Silke B. Targets and the emergency medical system – intended and unintended consequences. Eur J Emerg Med. epub ahead of print 16 April 2014
Publisher:
European Journal of Emergency Medicine
Journal:
European Journal of Emergency Medicine
Issue Date:
17-Jun-2014
URI:
http://hdl.handle.net/10147/321680
DOI:
10.1097/MEJ.0000000000000140
Item Type:
Article
Language:
en
Description:
Objective: There is interest in health service reform and efficiencies; health service providers collect statistics, set targets and compare institutions. In January 2009, in Ireland, a national waiting time target of 6 h was set from registration in the emergency department (ED) to admission or discharge. The aim of this study was to assess the consequences of the introduction of this target on our institution and the Acute Medical Admission Unit. Methods: All emergency medical admissions were tracked over 7 years and in-hospital mortality, length of stay and ED 'wait' numbers and times were summarized. Results: There were 43 471 admissions in 28 862 patients. In-hospital mortality for 2006-2008 averaged 5.9% [95% confidence interval (CI) 5.5-6.2%] compared with 4.8% (95% CI 4.6-5.1%) for 2009-2012 - a relative risk reduction of 18.3% (95% CI 11.5-24.5%) (P<0.001). The median length of stay was unaltered: 5.1 days (interquartile range 2.1-9.8) versus 5.0 days (interquartile range 2.0-9.5) (P=0.16). An ED 'first ward' allocation decreased six-fold with redistribution to the Acute Medical Admission Unit (two-fold increase) and the medical wards (four-fold increase). The time to on-call medical assessment decreased (time to team pre/post 4.5 vs. 4.2 h, P<0.001). However, calculations directly on the real-time log of arrival and first in-patient time showed a worsening of the position (time to ward pre/post 7.1 vs. 8.4 h, P<0.001). Conclusion: Target setting may result in unintended consequences in other areas in addition to its stated goal. These unintentional consequences of targets should be borne in mind by those planning and instituting healthcare reform.
Keywords:
HEALTH SERVICES AND THEIR MANAGEMENT; EMERGENCY MEDICAL CARE
Local subject classification:
PERFORMANCE INDICATORS
ISSN:
0969-9546

Full metadata record

DC FieldValue Language
dc.contributor.authorConway, Richarden_GB
dc.contributor.authorO’Riordan, Deirdreen_GB
dc.contributor.authorSilke, Bernarden_GB
dc.date.accessioned2014-06-17T09:16:25Z-
dc.date.available2014-06-17T09:16:25Z-
dc.date.issued2014-06-17-
dc.identifier.citationConway R, O'Riordan D, Silke B. Targets and the emergency medical system – intended and unintended consequences. Eur J Emerg Med. epub ahead of print 16 April 2014en_GB
dc.identifier.issn0969-9546-
dc.identifier.doi10.1097/MEJ.0000000000000140-
dc.identifier.urihttp://hdl.handle.net/10147/321680-
dc.descriptionObjective: There is interest in health service reform and efficiencies; health service providers collect statistics, set targets and compare institutions. In January 2009, in Ireland, a national waiting time target of 6 h was set from registration in the emergency department (ED) to admission or discharge. The aim of this study was to assess the consequences of the introduction of this target on our institution and the Acute Medical Admission Unit. Methods: All emergency medical admissions were tracked over 7 years and in-hospital mortality, length of stay and ED 'wait' numbers and times were summarized. Results: There were 43 471 admissions in 28 862 patients. In-hospital mortality for 2006-2008 averaged 5.9% [95% confidence interval (CI) 5.5-6.2%] compared with 4.8% (95% CI 4.6-5.1%) for 2009-2012 - a relative risk reduction of 18.3% (95% CI 11.5-24.5%) (P<0.001). The median length of stay was unaltered: 5.1 days (interquartile range 2.1-9.8) versus 5.0 days (interquartile range 2.0-9.5) (P=0.16). An ED 'first ward' allocation decreased six-fold with redistribution to the Acute Medical Admission Unit (two-fold increase) and the medical wards (four-fold increase). The time to on-call medical assessment decreased (time to team pre/post 4.5 vs. 4.2 h, P<0.001). However, calculations directly on the real-time log of arrival and first in-patient time showed a worsening of the position (time to ward pre/post 7.1 vs. 8.4 h, P<0.001). Conclusion: Target setting may result in unintended consequences in other areas in addition to its stated goal. These unintentional consequences of targets should be borne in mind by those planning and instituting healthcare reform.en_GB
dc.language.isoenen
dc.publisherEuropean Journal of Emergency Medicineen_GB
dc.rightsArchived with thanks to European Journal of Emergency Medicineen_GB
dc.subjectHEALTH SERVICES AND THEIR MANAGEMENTen_GB
dc.subjectEMERGENCY MEDICAL CAREen_GB
dc.subject.otherPERFORMANCE INDICATORSen_GB
dc.titleTargets and the emergency medical system – intended and unintended consequencesen_GB
dc.typeArticleen
dc.identifier.journalEuropean Journal of Emergency Medicineen_GB
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