NEAT metrics of the emergency department–inpatient interface: measures of patient flow and mortality for emergency admissions to hospital

Sullivan, Clair, Staib, Andrew, Eley, Rob, Scanlon, Alan, Flores, Judy and Scott, Ian (2015) NEAT metrics of the emergency department–inpatient interface: measures of patient flow and mortality for emergency admissions to hospital. Australian Health Review, 39 5: 533-538. doi:10.1071/AH14162


Author Sullivan, Clair
Staib, Andrew
Eley, Rob
Scanlon, Alan
Flores, Judy
Scott, Ian
Title NEAT metrics of the emergency department–inpatient interface: measures of patient flow and mortality for emergency admissions to hospital
Journal name Australian Health Review   Check publisher's open access policy
ISSN 1449-8944
0156-5788
Publication date 2015-01-01
Year available 2015
Sub-type Article (original research)
DOI 10.1071/AH14162
Open Access Status Not yet assessed
Volume 39
Issue 5
Start page 533
End page 538
Total pages 6
Place of publication Clayton, VIC Australia
Publisher CSIRO Publishing
Language eng
Abstract Background Movement of emergency patients across the emergency department (ED)-inpatient ward interface influences compliance with National Emergency Access Targets (NEAT). Uncertainty exists as to how best measure patient flow, NEAT compliance and patient mortality across this interface.
Formatted abstract
Background Movement of emergency patients across the emergency department (ED)–inpatient ward interface influences compliance with National Emergency Access Targets (NEAT). Uncertainty exists as to how best measure patient flow, NEAT compliance and patient mortality across this interface.

Objective To compare the association of NEAT with new and traditional markers of patient flow across the ED–inpatient interface and to investigate new markers of mortality and NEAT compliance across this interface.

Methods Retrospective study of consecutive emergency admissions to a tertiary hospital (January 2012 to June 2014) using routinely collected hospital data. The practical access number for emergency (PANE) and inpatient cubicles in emergency (ICE) are new measures reflecting boarding of inpatients in ED; traditional markers were hospital bed occupancy and ED attendance numbers. The Hospital Standardised Mortality Ratio (HSMR) for patients admitted via ED (eHSMR) was correlated with inpatient NEAT compliance rates. Linear regression analyses assessed for statistically significant associations (expressed as Pearson R coefficient) between all measures and inpatient NEAT compliance rates.

Results PANE and ICE were inversely related to inpatient NEAT compliance rates (r = 0.698 and 0.734 respectively, P < 0.003 for both); no significant relation was seen with traditional patient flow markers. Inpatient NEAT compliance rates were inversely related to both eHSMR (r = 0.914, P = 0.0006) and all-patient HSMR (r = 0.943, P = 0.0001).

Conclusions Traditional markers of patient flow do not correlate with inpatient NEAT compliance in contrast to two new markers of inpatient boarding in ED (PANE and ICE). Standardised mortality rates for both emergency and all patients show a strong inverse relation with inpatient NEAT compliance.

What is known about the topic? Impaired flow of emergency admissions across the interface between ED and inpatient wards retards achievement of NEAT-compliance rates and adversely affects patient outcomes. Uncertainty exists as to which measures of patient flow and mortality outcomes correlate closely with NEAT-compliance rates for patients admitted from emergency departments.

What does this paper add? This study investigates the utility of two new markers of patient flow from ED to inpatient wards. The Practical Access Number for Emergency (PANE) is the number of patients in ED who have had their episode of ED care completed and are awaiting an inpatient bed at a particular point in time. The Inpatient Cubicles in Emergency (ICE) represents the theoretical number of ED cubicles blocked by boarding patients over a specified time interval (in this study 5 weekdays, Monday–Friday), based on the mean time boarders spent in ED during that interval. Both measures were shown to be significantly inversely related to inpatient NEAT compliance rates (i.e. as PANE and ICE increased, NEAT compliance decreased). In contrast, no relation was seen with traditional markers of patient flow (i.e. hospital bed occupancy and ED attendance numbers). HSMR for both all patients and emergency patients only demonstrated a strong inverse relation with inpatient NEAT compliance.

What are the implications for practitioners? When pursuing higher NEAT compliance rates, traditional markers of patient flow across the ED–inpatient interface may be misleading and adversely impact bed-management strategies and patient safety. Identifying when hospitals may be at risk of developing, or already in, a state of reduced access to emergency care may be performed more accurately using new flow markers such as PANE and ICE. The inverse relationship between inpatient NEAT compliance and HSMR, whether calculated for all patients or for emergency patients only, underscores the dependence of inpatient mortality on the swift flow of large volumes of emergency admissions across the ED–inpatient interface. This flow may be compromised by imposing additional demands on a limited number of commissionable beds by way of increasing ED demand and/or use of more beds for elective admissions.
Keyword Health Care Sciences & Services
Health Policy & Services
Health Care Sciences & Services
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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Created: Sun, 19 Apr 2015, 00:49:20 EST by Rob Eley on behalf of Medicine - Princess Alexandra Hospital