OBJECTIVE: To report the experience of implementing a 4-hour-rule program. DESIGN, SETTING AND PARTICIPANTS: A 3-2013 whole-of-hospital clinical service redesign program in a tertiary paediatric hospital in Western Australia, involving all patients presenting to the emergency department (ED) from 1 January 2009 to 31 December 2011. MAIN OUTCOME MEASURES: Percentage of patients admitted, discharged or transferred from the ED within 4 hours of arrival at triage, and percentage of patients discharged from inpatient wards before 10 am. RESULTS: The percentage of patients admitted, discharged or transferred within 4 hours of arrival at the ED increased from 87% in 2009 to 95% in 2011. Safety and quality measures, including the admission rate from the ED, unplanned reattendances at the ED within 48 hours of discharge, patient complaints and inhospital mortality, remained unchanged. The percentage of patients discharged from inpatient wards before 10 am increased from 18% in 2009 to 30% in 2011. CONCLUSIONS: The introduction of a 4-hour-rule program has resulted in improved timeliness of care for patients throughout the hospital, both in the ED and inpatient wards, with no adverse impact on the quality and safety of clinical care.
OBJECTIVE: To report the experience of implementing a 4-hour-rule program. DESIGN, SETTING AND PARTICIPANTS: A 3-2013 whole-of-hospital clinical service redesign program in a tertiary paediatric hospital in Western Australia, involving all patients presenting to the emergency department (ED) from 1 January 2009 to 31 December 2011. MAIN OUTCOME MEASURES: Percentage of patients admitted, discharged or transferred from the ED within 4 hours of arrival at triage, and percentage of patients discharged from inpatient wards before 10 am. RESULTS: The percentage of patients admitted, discharged or transferred within 4 hours of arrival at the ED increased from 87% in 2009 to 95% in 2011. Safety and quality measures, including the admission rate from the ED, unplanned reattendances at the ED within 48 hours of discharge, patient complaints and inhospital mortality, remained unchanged. The percentage of patients discharged from inpatient wards before 10 am increased from 18% in 2009 to 30% in 2011. CONCLUSIONS: The introduction of a 4-hour-rule program has resulted in improved timeliness of care for patients throughout the hospital, both in the ED and inpatient wards, with no adverse impact on the quality and safety of clinical care.
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 Journal: PLoS One Date: 2018-03-14 Impact factor: 3.240
Authors: Tim Tenbensel; Linda Chalmers; Peter Jones; Sarah Appleton-Dyer; Lisa Walton; Shanthi Ameratunga Journal: BMC Health Serv Res Date: 2017-09-26 Impact factor: 2.655
Authors: Roberto Forero; Shizar Nahidi; Josephine de Costa; Daniel Fatovich; Gerry FitzGerald; Sam Toloo; Sally McCarthy; David Mountain; Nick Gibson; Mohammed Mohsin; Wing Nicola Man Journal: BMC Health Serv Res Date: 2019-01-30 Impact factor: 2.655