title: Is a national time target for emergency department stay associated with changes in the quality of care for acute asthma? A multicentre pre-intervention post-intervention study.
abstract: OBJECTIVE
  There is debate whether targets for ED length of stay introduced to reduce ED overcrowding are helpful or harmful, as focus on a process target may divert attention from clinical care. Our objective was to investigate the effect of a national ED target in Aotearoa New Zealand on the recommended care for acute asthma as this is known to suffer in overcrowded departments.
  
  
  METHODS
  We conducted a retrospective chart review study across four sites from 2006 to 2012 (target introduced mid 2009). The primary outcome was time to steroids in the ED. The secondary outcomes were other aspects of asthma care in ED. We used general linear models or logistic regression as appropriate to assess care before and after the target.
  
  
  RESULTS
  Among the 570 (of 1270 randomly selected cases) eligible for analysis, no difference was demonstrated in time to steroids: least square mean (95% CI) = 58.1 (49-67.5) min before and 50.4 (42.9-55.8) min after the target (P = 0.15). More patients received steroids in ED after the target, OR (95% CI) = 2.1 (1.2-4.3). No differences were demonstrated in those receiving steroid prescriptions or re-presentations: OR (95% CI) = 1.3 (0.9-1.96) and 1.1 (0.5-2.3), respectively. Changes in pre-target and post-target ED and hospital length of stay varied between hospitals.
  
  
  CONCLUSIONS
  Introduction of the target was not associated with a change in times to steroids in ED, although more patients received steroids in ED indicating closer adherence to recommended practice.
authors.affiliation: Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.affiliation: Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Susan
authors.initials: S
authors.lastname: Wells
authors.affiliation: Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Alana
authors.initials: A
authors.lastname: Harper
authors.affiliation: Adult Emergency, Auckland District Health Board, Auckland, New Zealand.
authors.forename: James
authors.initials: J
authors.lastname: LeFevre
authors.affiliation: Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Joanna
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Te Kupenga Hauora Māori, School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Elana
authors.initials: E
authors.lastname: Curtis
authors.affiliation: Te Kupenga Hauora Māori, School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Papaarangi
authors.initials: P
authors.lastname: Reid
authors.affiliation: Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Shanthi
authors.initials: S
authors.lastname: Ameratunga
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D065187:Controlled Before-After Studies; D003441:Crowding; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009520:New Zealand; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D018927:Anti-Asthmatic Agents; D013256:Steroids
keywords: asthma; crowding; emergency medicine; quality indicator; time target