Objective Time targets for ED stays are used as a policy instrument to reduce ED crowding. There is debate whether such policies are helpful or harmful, as focus on a process target may divert attention from clinical care. The objective of this study is to investigate whether the Shorter Stays in Emergency Departments target in New Zealand was associated with a change in the quality of ED discharge information provided to primary care providers.
Methods The quality of discharge summaries was assessed retrospectively over time using chart review. Logistic regression was used to account for secular trends with adequate or not as the dependent variable. Explanatory variables were: age, ethnicity, deprivation, triage category, year, the step at target introduction (2009) and the change in slope before and after the target.
Results Of 500 randomly selected discharge summaries, 491 (98.2%) were included in the analysis. There was evidence of a decrease over time in the proportion of adequate discharge summaries before the introduction of the target (slope estimate (SE) −0.43 (0.20), p=0.02). A step at the target introduction could not be shown (p=0.47). There was evidence of an improvement over time from pre-target to post-target: slope afterwards 0.33, estimate of change in slope (SE) 0.76 (0.27), p=0.006.
Conclusions There was no reduction in the quality of discharge summaries following the introduction of the shorter stays in ED target and trends in quality improved. These findings deserve replication in other hospitals which may experience different challenges.
- emergency care systems, emergency departments
- performance improvement
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Contributors PJ conceived the idea for the study, and PJ, AH, SW, SA, EC and PR chose the outcome of interest for this paper. AH designed and piloted the tool to assess quality of discharge summaries. PJ and AH constructed and piloted the data collection tool. JW collected the data, which was checked by AH. JS was the biostatistician for the study. AH wrote the first draft the paper which was reviewed and modified by PJ with the assistance of JLF, SW, SA, EC, PR JS and JW. PJ takes overall responsibility for the content of the manuscript.
Funding The Health Research Council of New Zealand funds the Shorter Stays in Emergency Departments National Research Project HRC 10-588. JW was supported by an A+ Trust Summer Student Grant (A+4822) during the time she worked on the study.
Competing interests None declared.
Ethics approval Multi regional Ethics Committee of the NZ Health and Disability Ethics Committees MEC/1006/60.
Provenance and peer review Not commissioned; externally peer reviewed.
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