Impact of the Four-Hour Rule in Western Australian hospitals: Trend analysis of a large record linkage study 2002-2013

• DOI: 10.1371/journal.pone.0193902
• Publication Date: 2018-03-14T13:39:03Z
• Authors: Hanh Ngo; Roberto Forero; David Mountain; Daniel Fatovich; Wing Nicola Man; Peter Sprivulis; Mohammed Mohsin; Sam Toloo; Antonio Celenza; Gerard Fitzgerald; Sally McCarthy; Ken Hillman
• Keywords: Attendance; Quarter (Canadian coin); Interrupted time series; Trend analysis

Background In 2009, the Western Australian (WA) Government introduced Four-Hour Rule (FHR) program. The policy stated that most patients presenting to Emergency Departments (EDs) were be seen and either admitted, transferred, or discharged within 4 hours. This study utilised de-identified data from five participating hospitals, before after FHR implementation, assess impact of on several areas ED functioning. Methods A state population-based intervention design, using longitudinal obtained administrative health databases via record linkage methodology, interrupted time series analysis technique. Findings There 3,214,802 presentations, corresponding 1,203,513 patients. After access block for admitted through all sites showed a significant reduction up 13.2% (Rate Ratio 0.868, 95%CI 0.814, 0.925) per quarter. Rate attendances hospitals continued rise throughout entire period unaffected by FHR, except one hospital. Pattern change in re-attendance rate post-FHR was similar pre-FHR, but trend reduced two hospitals. occupancy 6.2% quarter 'crowded' ED. length stay efficiency improved four deteriorated Time being clinician Did-Not-Wait some Admission rates increased, 1% quarter, where pre-FHR decreasing. Conclusions had consistent effect 'flow' measures: significantly reducing overcrowding enhancing efficiency. Time-based outcome measures mostly with FHR. is evidence increased attendance, no re-attendance. Effects patient disposition status mixed. Overall, this reflects value investing resources into ED/hospital system improve experience. Further research required illuminate exact mechanisms effects hospital functioning across Australia.