Improvement in emergency department length of stay using a nurse-led 'emergency journey coordinator': a before/after study.
OBJECTIVE
Australian EDs are required to conform to the National Emergency Access Target (NEAT): patients must depart within 4 h of arrival. The study's aim was to determine if a nursing role called the 'Emergency Journey Coordinator' (EJC) improved NEAT through resolving delays in patient processing.


METHODS
The proportion of patients achieving NEAT before and after the EJC role started were compared with adjustment for confounding variables. All data were obtained from the ED computer management system.


RESULTS
There were 23 848 patients over a 128 day period before and 20 884 over a 115 day period after the introduction of the EJC role. The proportion of patients meeting NEAT after the EJC role started was 64.4% compared with 59.6% before, an absolute improvement of 4.9% (95% confidence interval [CI] 4.0-5.8, P < 0.001). This benefit persisted after controlling for confounding effects. For patients admitted NEAT was 38.1% after the EJC role started compared with 32.5% before, an absolute improvement of 5.6% (95% CI 4.1-7.1, P < 0.001). For patients discharged, NEAT was 80.2% after the EJC role started compared with 74.6% before, an absolute improvement of 5.6% (95% CI 4.7-6.6, P < 0.001). Mean ED occupancy decreased from 34.3 patients before to 32.4 after, a decrease of 2.0 patients (95% CI 1.2-2.8, P < 0.001). There was no clinically important difference in the proportion of patient who did not wait to be seen or in ambulance transfer of care time.


CONCLUSIONS
NEAT targets were improved in the ED of a tertiary referral hospital after the introduction of the EJC role.
Emergency Department, St George Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia.
Stephen E
SE
Asha
Allan
A
Ajami
D000328:Adult; D000368:Aged; D016529:Emergency Nursing / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009517:New South Wales; D024802:Nurse's Role; D010043:Outcome and Process Assessment, Health Care; D055815:Young Adult
crowding; emergency service; health services accessibility; hospital; length of stay; model; nursing