A new Deeble Institute for Health Policy Research Issues Brief has shown the pitfalls of using the National Emergency Access Target (NEAT) to reduce the length of stay in hospital Emergency Departments (EDs) and improve overall patient outcomes.
NEAT used a single, time-based target to incentivise patient flow and was adopted across Australia in 2011 with the aim of reducing 90% of all ED stays to four hours or less. This followed a 65% rise in presentations in the preceding decade.
The National Emergency Access Target: aiming for the target but what about the goal? by Deeble Scholar Katharine Silk, found that hospitals have been unable to achieve the targets, despite some improvement in NEAT attainment. NEAT was found to have increased hospital admissions, potentially reducing patient flow.
“Reform using a single, incentivised, process-based mechanism is unlikely to achieve broad changes to the effectiveness, safety, quality and equity of care provision, and risks producing unintended consequences,” Ms Silk wrote.
“It is for these reasons that the NEAT policy at present cannot be considered a complete success.”
“This research also highlights the importance of policymaking processes in ensuring policy intentions are achieved. It is critical to ensure that appropriate policy instruments and evaluation methods are chosen in order to provide the appropriate incentives for institutional change. Process measures such as time targets for the evaluation of healthcare must be used with caution, as they describes healthcare processes but do not reflect the outcomes or quality of care. This is further complicated by the use of financial incentives as drivers of change.”
“We commend this Issues Brief to policymakers and health leaders,” Australian Healthcare and Hospitals Association Chief Executive Alison Verhoeven said.
“The failure of NEAT to achieve the necessary broad change and improve patient outcomes shows the need for whole-of-hospital reforms to improve patient flow.”
View the full Issues Brief here.
Chief Executive, The Australian Healthcare and Hospitals Association
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