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dc.contributor.authorConway, Richard
dc.contributor.authorO’Riordan, Deirdre
dc.contributor.authorSilke, Bernard
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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