Is a national time target for emergency department stay associated with changes in the quality of care for acute XXXX ? A multicentre pre-intervention post-intervention study.

@entity1 @entity565 @entity2613 @entity230 @entity479
OBJECTIVE: There is debate whether targets for @entity2613 length of stay introduced to reduce @entity2613 overcrowding are helpful or harmful, as focus on a process target may divert attention from clinical care. Our objective was to investigate the effect of a national @entity2613 target in Aotearoa New Zealand on the recommended care for acute @entity565 as this is known to suffer in overcrowded departments. METHODS: We conducted a retrospective chart review study across four sites from 2006 to 2012 (target introduced mid 2009). The primary outcome was time to @entity230 in the @entity2613 . The secondary outcomes were other aspects of @entity565 care in @entity2613 . We used general linear models or logistic regression as appropriate to assess care before and after the target. RESULTS: Among the 570 (of 1270 randomly selected cases) eligible for analysis, no difference was demonstrated in time to @entity230 : least square mean (95% CI)   =   58.1 (49-67.5) min before and 50.4 (42.9-55.8) min after the target (P   =   0.15). More @entity1 received @entity230 in @entity2613 after the target, OR (95% CI)   =   2.1 (1.2-4.3). No differences were demonstrated in those receiving @entity479 prescriptions or re-presentations: OR (95% CI)   =   1.3 (0.9-1.96) and 1.1 (0.5-2.3), respectively. Changes in pre-target and post-target @entity2613 and hospital length of stay varied between hospitals. CONCLUSION: Introduction of the target was not associated with a change in times to @entity230 in @entity2613 , although more @entity1 received @entity230 in @entity2613 indicating closer adherence to recommended practice.
