Michael Hession
Western Sydney University, Australia
Title: Gaming National Emergency Access Target (NEAT) performance using Emergency Treatment Performance (ETP) defi nitions and ED short stay units.
Biography
Biography: Michael Hession
Abstract
Objective: The objective of the present study is to evaluate potential gaming of the four-hour metric known as the National Emergency Access Target (NEAT) in Australia and Emergency Treatment Performance (ETP) in NSW. Methods: Descriptive statistical analysis was used to recalculate and compare the scores for NEAT and the NSW ETP metric with 32,148 presentations during 2016. The effect on the ETP score of a reclassifi cation of patients was assessed. A computer simulation using a discrete event model illustrated the effect of the use of ED short stay beds on the ETP scores. Results: Using the ETP timestamp of the intent to discharge a patient, called, ‘ready for departure’ instead of the time of physically leaving the department which is used in the NEAT defi nition, resulted in an apparent 6% performance improvement. A local interpretation of the NSW state defi nition of the ‘transferred’ patient resulted in the ETP for ‘admitted’ patients improving by 16%. The discrete event model demonstrated that without changing patient length of stay, ETP scores can be improved by or optimizing the time of the admit decision or increasing the number of ED short stay beds. Conclusions: The opportunity of NEAT may be squandered unless gaming of the defi nitions and use of ED short stay beds is addressed. We argue that the longstanding issue of ‘departure time’ should be defi ned as ‘physically leaving’ the department which is a real measure of ED resource use and that NSW and national recommendations should be adjusted. ACEM accreditation of EDs should include review of their application of NEAT defi nitions so that they truly refl ect patient fl ow processes. Biography