SA Footy

Four-hour ED target of no proven benefit 13-Jul-2010 By Michael East

The Federal Government’s commitment to ensure all ED patients are treated within four hours will not improve patient care, UK research suggests.
The “four-hour access target” is a key aspect of the government’s health reforms, with $500 million being spent to guarantee ED patients will be admitted to hospital, referred for treatment or discharged in under four hours.

In the UK, the introduction six years ago of a similar target — which aimed to ensure 98% of patients were seen within four hours — resulted in almost one-third of all admitted patients admitted in only the last 20 minutes of the four-hour period (see graph in article). Before the target was introduced only about 10% of patients were admitted in the final 20 minutes. “We have no evidence that the … four-hour target benefits clinical care, and our findings suggest that it has encouraged target-led rather than needs-led care,” the researchers from Sheffield University wrote in the BMJ (online).

UK’s newly elected Conservative/Liberal Democrat Government will scrap the four-hour target next year, amid claims it has increased mortality rates, with patients misdiagnosed, placed in the wrong wards or discharged prematurely.

Despite this, Federal Health Minister Nicola Roxon confirmed that the four-hour target would be implemented in Australia from 1 January next year.
It will initially apply only to triage category one patients.

The Department of Health and Ageing has previously stated that, under the four-hour target, EDs could refer patients to general practices where it was clinically appropriate.
Should a patient still insist on being treated in the ED, their “four-hour clock” would be reset to zero.