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Title: Comparison of emergency department time performance between a Canadian and an Australian academic tertiary hospital.
Austin Authors: Cheng, Ivy;Taylor, David McD ;Schull, Michael J;Zwarenstein, Merrick;Kiss, Alex;Castren, Maaret;Brommels, Mats;Yeoh, Michael;Kerr, Fergus
Affiliation: Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Emergency Medicine, Helsinki University, Helsinki, Finland
Medical Management Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, University of Toronto, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
Department of Clinical Science and Education, Sodersjukhuset-Karolinska Institutet, Stockholm, Sweden
Austin Health, Heidelberg, Victoria, Australia
Issue Date: 2019 2019-02-27
Publication information: Emergency Medicine Australasia : EMA 2019; 31(4): 605-611
Abstract: To compare performance and factors predicting failure to reach Ontario and Australian government time targets between a Canadian (Sunnybrook Hospital) and an Australian (Austin Health) academic tertiary-level hospitals in 2012, and to assess for change of factors and performance in 2016 between the same hospitals. This was a retrospective, observational study of patient administrative data in two calendar years. The main outcome measure was reaching Ontario and Australian ED time targets for admissions, high and low urgency discharges. Secondary outcomes were factors predicting failure to reach these targets. Between 2012 and 2016, Sunnybrook and Austin experienced increased patient volume of 10.2% and 19.2%, respectively. Bed capacity decreased at Sunnybrook (-10.8%) but increased at the Austin (+30.3%). For both years, Austin failed to achieve the Australian time target, but succeeded for all Ontario targets except for low urgency discharges. Sunnybrook failed all targets irrespective of year. The top factors for failing Ontario ED length-of-stay targets for both hospitals in 2012 and 2016 were bed request greater than 6 h, access block greater than 1 h, use of cross-sectional imaging, consultation and waiting for the emergency physician greater than 2 h. Austin outperformed Sunnybrook for Ontario and Australian government time targets. Both hospitals failed the Australian targets. Factors predicting failure to achieve targets were different between hospitals, but were mainly clinical resources. Sunnybrook focussed on increasing human resources. Austin focussed on increasing human resources, observation unit and hospital beds. Intrinsic hospital characteristics and infrastructure influenced target success.
DOI: 10.1111/1742-6723.13247
ORCID: 0000-0001-7740-9558
PubMed URL: 30811092
Type: Journal Article
Subjects: emergency department crowding
health services research
pay for performance
Appears in Collections:Journal articles

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