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Title: Increased burden on metropolitan urological services: The era of the Australian National Emergency Access Targets (NEAT or the "4-h target").
Austin Authors: Perera, Marlon L;Gnaneswaran, Neiraja;Roberts, Matthew J;Lawrentschuk, Nathan;Ritchie, Peter;Chan, Steven T F
Affiliation: Department of Surgery, Mackay Base Hospital, Mackay, Australia
The University of Queensland, School of Medicine, Brisbane, Australia
The University of Queensland, Centre for Clinical Research, Brisbane, QLD 4006, Australia
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
Peter MacCallum Cancer Centre, Division of Cancer Surgery, Melbourne, Australia
Department of Emergency, Western Health, Footscray VIC, QLD, Mackay, Australia
Department of Surgery, Western Health, Footscray, VIC, Mackay, Australia
Academic Surgery, University of Melbourne, Victoria, Australia
Issue Date: Apr-2018
Publication information: Urology annals 2018 Apr-Jun; 10(2): 146-149
Abstract: The National Emergency Access Targets (NEAT) was introduced in Australia in 2011 and guides the clearance of presentations within 4-h of initial presentation from the Emergency Department (ED). We aim to assess the impact of the introduction of NEAT on acute urological services at a large metropolitan center. A retrospective cohort study was performed and data were collected from electronic patient management systems. The control group was represented by ED presentations between June and September 2011, 1 year prior to the introduction of NEAT. The two study groups consisted of ED presentations between June and September 2012 and 2013, respectively. Outcome measures included time to the ureteric stent and scrotal exploration, inpatient length of stay (IPLOS), out-of-hours operating, and hospital mortality rates. Across the three study periods, a total of 76,935 patients were assessed by the EDs of the health service. 225 urological inpatient episodes were included across all periods with a trend showing increasing numbers of admissions (P = 0.003). For patients admitted under the urological service: Waiting room time and ED length of stay decreased significantly (P < 0.001). Proportion of operative cases decreased insignificantly (P = 0.275). Time from emergency presentation to emergency ureteric stent remained unchanged, however, proportions of procedures performed out-of-hours showed an increasing trend (P < 0.001). A significant increase in inter-unit transfer was observed, however, median IPLOS and mortality for operative and nonoperative cases remain unchanged. Concerning urological admissions, the implementation of NEAT has been associated with improvement in ED key performance indicators. Such changes have been correlated with reductions in operative cases and increases in out-of-hours emergency operating. Further research is required to evaluate the direct effect of NEAT on urological patient care.
DOI: 10.4103/0974-7796.164843
ORCID: 0000-0002-1138-6389
PubMed URL: 29719324
ISSN: 0974-7796
Type: Journal Article
Subjects: Emergencies
length of stay
quality of health care
Appears in Collections:Journal articles

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