title: Re-engineering an Australian emergency department: can we measure success?
abstract: In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. Clinically, there were great improvements in waiting times, time to thrombolysis in acute myocardial infarction, complaint rate, and misdiagnosed fracture rate. Increased throughput of short stay patients in a re-opened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re-engineering an emergency department can be shown to improve the quality-of-care.
authors.affiliation: Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
authors.forename: G A
authors.initials: GA
authors.lastname: Jelinek
authors.forename: D
authors.initials: D
authors.lastname: Mountain
authors.forename: D
authors.initials: D
authors.lastname: O'Brien
authors.forename: I R
authors.initials: IR
authors.lastname: Rogers
authors.forename: G
authors.initials: G
authors.lastname: Wilkes
authors.forename: J
authors.initials: J
authors.lastname: Wenban
authors.forename: J
authors.initials: J
authors.lastname: Carr
authors.forename: S
authors.initials: S
authors.lastname: O'Keefe
authors.forename: P J
authors.initials: PJ
authors.lastname: Martin
mesh_terms: D001315:Australia; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D050723:Fractures, Bone / Q000175:diagnosis; D006754:Hospital Restructuring; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy; D017063:Outcome Assessment, Health Care / Q000379:methods; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care; D015912:Thrombolytic Therapy; D014850:Waiting Lists