• Emergency care systems

In January the government of Western Australia (WA) published a comprehensive 84 page review of the 4 h rule programme (FHRP) introduced there in April 2009.1 It focuses on the stage one hospitals, Fremantle, Princess Margaret, Royal Perth and Sir Charles Gairdner that were the pioneers of the programme in WA and Australia.

Its interesting to note that the review was implemented after stories in local newspapers revealed complaints from the Australian Medical Association and the Royal Australasian College of Surgeons regarding the FHRP; the papers reported that 80% of junior doctors said it was compromising their ability to care for patients properly and was affecting their training, 89% said they were feeling pressure from other staff, the FHRP had shifted the problem of access block out of the emergency department (ED) to the wards, patients were being sent to the wrong wards and wards where a bed was not immediately available compromised privacy by placing the patient in a circulation area or in a corridor.

Here are selected highlights from the review:

• The magnitude of the achievements in the WA stage one hospitals cannot be overestimated; all four …