title: The National Emergency Access Target (NEAT): can quality go with timeliness?
abstract: OBJECTIVE
  To report the experience of implementing a 4-hour-rule program.
  
  
  METHODS
  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.
  
  
  METHODS
  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: Princess Margaret Hospital for Children, Perth, WA, Australia.
authors: Liana
authors: L
authors: Maumill
authors: Mia
authors: M
authors: Zic
authors: Amanda A
authors: AA
authors: Esson
authors: Gary C
authors: GC
authors: Geelhoed
authors: Meredith M
authors: MM
authors: Borland
authors: Christopher
authors: C
authors: Johnson
authors: Philip
authors: P
authors: Aylward
authors: Andrew C
authors: AC
authors: Martin
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007902:Length of Stay; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards*; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000592:standards; D014904:Western Australia