title: Junior doctor strike model of care: Reduced access block and predominant Fellow of the Australasian College for Emergency Medicine staffing improve emergency department performance.
abstract: OBJECTIVE
  To describe the response and analyse ED performance during a 5-day junior doctor strike.
  
  
  METHODS
  Data were collected via the patient information management computer system. Key performance indicators included percentage seen within maximum waiting times per triage category (TC), ED length of stay, emergency medicine patients who did not wait to be seen, hospital bed occupancy and access block percentage. Comparisons were made for the same 5 days before the strike (BS), during the strike (S) and after the strike.
  
  
  RESULTS
  Total doctor's shifts BS were 78.66 with 25% of these shifts being Fellow of the Australasian College for Emergency Medicine (FACEM) shifts. FACEM shifts were more common during the S period at 75% (P < 0.001). Total attendances (BS 631 vs S 596, P = 0.22) and TC percentages (P-values for TC 1, 2, 3, 4, 5, respectively, 1.0, 0.55, 0.88, 0.97, 0.46) in the BS, S and after-the-strike periods were not significantly different. Despite fewer total doctor shifts, the FACEM predominant model of care during the strike resulted in better percentages seen within the maximum waiting times for TC3 (66%), TC4 (78%) and TC5 (86%) (all P < 0.001). There was a reduction in patients who did not wait to be seen (28 BS vs 5 S, P < 0.001), ED length of stay (admissions: BS 451 min vs S 258 min, P < 0.001; discharges: BS 233 min vs S 144 min, P < 0.02) and referrals to inpatient services (P = 0.02). This occurred with reduced bed point occupancy of 66% and a consequent reduction in access block.
  
  
  CONCLUSIONS
  FACEM staffing and reduced access block were significant factors in improved ED performance.
authors.affiliation: Emergency Medicine Education and Research Middlemore Hospital, Auckland, New Zealand. vthornton@middlemore.co.nz
authors.forename: Vanessa
authors.initials: V
authors.lastname: Thornton
authors.forename: Wayne
authors.initials: W
authors.lastname: Hazell
mesh_terms: D001315:Australia; D001509:Bed Occupancy / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational / Q000592:standards* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D011787:Quality of Health Care; D012189:Retrospective Studies; D012577:Schools, Medical / Q000458:organization & administration / Q000592:standards*