Emergency department waiting times: do the raw data tell the whole story?

Abstract

Objective. To determine whether there are real differences in emergency department (ED) performance between Australian states and territories.Methods. Cross-sectional analysis of 2009À10 attendances at an ED contributing to the Australian non-admitted patient ED care database. The main outcome measure was difference in waiting time across triage categories.Results. There were more than 5.8 million ED attendances. Raw ED waiting times varied by a range of factors including jurisdiction, triage category, geographic location and hospital peer group. All variables were significant in a model designed to test the effect of jurisdiction on ED waiting times, including triage category, hospital peer group, patient socioeconomic status and patient remoteness. When the interaction between triage category and jurisdiction entered the model, it was found to have a significant effect on ED waiting times (P < 0.001) and triage was also significant (P < 0.001). Jurisdiction was no longer statistically significant (P = 0.248 using all triage categories and 0.063 using only Australian Triage Scale 2 and 3).Conclusions. Although the Council of Australian Governments has adopted raw measures for its key ED performance indicators, raw waiting time statistics are misleading. There are no consistent differences in ED waiting times between states and territories after other factors are accounted for.What is known about the topic? The length of time patients wait to be treated after presenting at an ED is routinely used to measure ED performance. In national health agreements with the federal government, each state and territory in Australia is expected to meet waiting time performance targets for the five ED triage categories. The raw data indicate differences in performance between states and territories. What does this paper add? Measuring ED performance using raw data gives misleading results. There are no consistent differences in ED waiting times between the states and territories after other factors are taken into account. What are the implications for practitioners? Judgements regarding differences in performance across states and territories for triage waiting times need to take into account the mix of patients and the mix of hospitals.

The impact of Australian healthcare reforms on emergency department time-based process outcomes: An interrupted time series study

“…Improvement in the timeliness of accessing emergency care and the LOS following the introduction of national healthcare reforms varied across hospital peer groups, with the greatest improvement in small hospitals. This is consistent with previous Australian research which showed that small hospitals have the shortest waiting time to treatment [39] and patients were more likely to depart the ED within four hours of arrival than in major, large and medium hospitals [40]. Such improvements are likely to be dependent on individual hospitals’ behavioural responses to government targets and initiatives undertaken to address them.…”

The Australian public's preferences for emergency care alternatives and the influence of the presenting context: a discrete choice experiment

“…Although there was a different pattern of preferences evident for accessing care when presentations involved new concerns and possible chronic problems compared with an acute injury, the heterogeneity observed may also help explain why a substantial proportion of ED presentations continue to be considered ‘inappropriate’ 11 22 50 52 even when ambulatory alternatives are available. 26 It is likely that a range of situational or sociodemographic factors may impact preferences 1 and these will be explored in future analyses.…”

“…Emergency departments (EDs) primarily exist to treat people experiencing medical emergencies, but often provide services to patients with a range of presenting problems of less urgency. 1–4 Both within Australia and internationally, demand for emergency care has been increasing each year leading to substantial ED pressures. 2 3 5–7 Although the causes of ED overcrowding are complex, sociodemographic changes, including population growth and ageing, and clinical considerations, such as increasing comorbidities, are key contributors to excessive demand.…”