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When hospitals fail to cope with demands for acute care one manifestation is overcrowding of the emergency department (ED). ED overcrowding is associated with a number of adverse consequences, including patient deaths.1-6
In response to concerns about ED overcrowding7 and pressure for more focus on acute care (including the recommendations of the Working Group for Achieving Quality in Emergency Departments8), on 1 July 2009 'Shorter Stays in Emergency Departments' (the Target) became one of six national Health Targets in New Zealand. The Target is defined as '95% of patients will be admitted, discharged or transferred from an emergency department within 6 hours'.
At the time of this study New Zealand had 21 District Health Boards (DHBs) which plan, manage, provide and purchase health services for the population of their district.9 Administered by these DHBs are 28 hospitals with EDs of appropriate role delineation (level three and above10) to be subject to the Target.
A small team was formed in the Ministry (the three authors) to facilitate and lead progress towards the Target. As part of this, a priority activity for the team during the first year was to visit each DHB to gain an understanding of their specific challenges and successes in relation to the Target. In addition, the team reviewed documentation from each DHB including a 'Delivery Plan for achieving Shorter Stays in ED'. The delivery plans were intended to be comprehensive, prioritised, 'whole of system' plans detailing the DHB's challenges and how they intended to overcome them.11
The visits and associated information from DHBs provided a unique national overview of the challenges facing DHBs in their pursuit of better acute care, the resolution of ED overcrowding, and consequent achievement of the Target. The aim of this study was to collate the 10 most common challenges and discuss how DHBs are addressing them.
Methods
All DHBs were visited between 1 July 2009 and 1 July 2010. The visits were attended by the National Clinical Director of ED Services (MA) and one or both of the two other members of the Shorter Stays in ED team (GT and/or CP). The visits took a standardised format which included an initial meeting with senior clinicians and managers to discuss the purpose of the visit and general issues...