title: The effect of the Shorter Stays in Emergency Departments health target on the quality of ED discharge summaries.
abstract: OBJECTIVE
  Time targets for ED stays are used as a policy instrument to reduce ED crowding. There is debate whether such policies are helpful or harmful, as focus on a process target may divert attention from clinical care. The objective of this study is to investigate whether the Shorter Stays in Emergency Departments target in New Zealand was associated with a change in the quality of ED discharge information provided to primary care providers.
  
  
  METHODS
  The quality of discharge summaries was assessed retrospectively over time using chart review. Logistic regression was used to account for secular trends with adequate or not as the dependent variable. Explanatory variables were: age, ethnicity, deprivation, triage category, year, the step at target introduction (2009) and the change in slope before and after the target.
  
  
  RESULTS
  Of 500 randomly selected discharge summaries, 491 (98.2%) were included in the analysis. There was evidence of a decrease over time in the proportion of adequate discharge summaries before the introduction of the target (slope estimate (SE) -0.43 (0.20), p=0.02). A step at the target introduction could not be shown (p=0.47). There was evidence of an improvement over time from pre-target to post-target: slope afterwards 0.33, estimate of change in slope (SE) 0.76 (0.27), p=0.006.
  
  
  CONCLUSIONS
  There was no reduction in the quality of discharge summaries following the introduction of the shorter stays in ED target and trends in quality improved. These findings deserve replication in other hospitals which may experience different challenges.
authors.affiliation: Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Alana
authors.initials: A
authors.lastname: Harper
authors.affiliation: Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.affiliation: Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Jordon
authors.initials: J
authors.lastname: Wimsett
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: Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand.
authors.forename: James
authors.initials: J
authors.lastname: Le Fevre
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: 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: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D063886:Patient Discharge Summaries / Q000592:standards* / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage
keywords: communications; emergency care systems, emergency departments; performance improvement; quality; systems