Monthly Archives: April 2012

When ‘The Feds’ announced in Australia that one of the central planks of health reform would due be a  ‘Four hour National Emergency Access Target’ it raised more than a few eyebrows.

Everyone, from the Australian Medical Association, The Australasian College of Emergency Medicine and even the medical students had their say.

The questions are pretty obvious – Time based targets don’t guarantee good outcomes do they? People get stuck in ED because there aren’t enough beds/doctors/nurses, so will there be more? Aren’t other jurisdictions moving away from time based targets?

Sure, it’s all true and when The Last General Cardiologist was working on redesign of clinical systems around chest pain at around that time it also seemed hard to see how this could all work for that most common of potential cardiac complaints; acute, undifferentiated chest pain.

But what is also true is that the state of a hospital, and more widely a health system, is frequently judged by the public, the media and hence politicians by the state of its EDs. More specifically how much tedious waiting is required when you tear of your ear in a rugby match, wake up with croup or dislocate your ACJ (the only reasons for TLGC’s infrequent attendances at an ED in recent years). Thus, ‘The Four Hour Rule’ is undoubtedly here to stay…

So it is timely that we see some of the first evidence emerging from Australian EDs that there may be a link between delays in ED and outcomes…

Emergency department overcrowding, mortality and the 4-hour rule in Western Australia by Gary C Geelhoed and Nicholas H de Klerk in the Medical Journal of Australia 2012; 196 (2): 122-126.

Yes there are caveats, and Drew Richardson’s accompanying commentary raises important issues to consider

Interestingly, since TLGC started work on clinical redesign around chest pain there has been rapid growth in the emergence of evidence for more accelerated clinical processes as outlined in this previous post.

Watch this space…