Effect of a hospital-wide multimodal intervention on Emergency Department crowding, function and outcomes at Canberra Hospital and Health Services

Emergency Department (ED) Overcrowding is associated with reduced performance in standard process and flow measures, and worse patient outcomes including mortality. Access block, the situation of patients experiencing prolonged delays in the ED whilst waiting for an inpatient bed, is a particular issue for which the solutions lie outside the ED. There have been several detailed reports on effective hospital-wide interventions in Australia, with demonstrated improvements in process and flow and some evidence of mortality benefit. However, all of the previous reports have been retrospective and thus may suffer from publication bias. The aim of this study is to prospectively document the effects of a multimodal hospital-wide intervention on ED process, flow, and outcomes. In late 2015 and early 2016, The Canberra Hospital is undertaking such an intervention. This study will examine the effects using retrospective controls, Primary outcomes will be the workload caused by excessive inpatients in ED (hours per week with more than 13 inpatients in ED) and ED flow as measured by the standard National Emergency Access Target (4 hours). Secondary outcomes will be standard hospital measures including length of stay, readmission rates, and mortality.