South Western Sydney Clinical School

Access block and Emergency Department (ED) overcrowding have been described as the most serious issues confronting EDs in the developed world, as these problems compromise the quality and timeliness of patient care. There is an urgent need to understand if the four hour rule is effective in reducing access block and overcrowding, and how patients are affected. The four-hour rule, where 98% of patients must spend less than 4-hours in ED from arrival to admission, transfer or discharge is being implemented in WA. We need to
find out if this is effective in reducing access block and ED overcrowding.

The main purpose is to validate the impact of the intervention in WA and compare it with similar hospitals in other states with data linkage capability. To assess the impact of the four-hour rule, this study will use a reference point retrospective data linkage study in WA and conduct comparisons across states on admitted adult patients before and during the implementation of the WA intervention. This is from 2005-2011, from 15 of the busiest hospitals in Australia. Data linkage techniques will be used to explore patient as well as hospital key performance indicators. We also use a multilevel analysis approach to assess the hospital characteristics.

The findings of this study will enable us to assess the effectiveness of policy interventions and translate the recommended evidence based changes into policy and clinical service delivery. This partnership is also a unique opportunity to meet the need for a more effective integration of evidence into health services research policy and service delivery. We expect that our findings will encourage researchers and partner organisations to form alliances of national and international significance to improve the quality of policy interventions and programs.