In Western Australia, in 2008, a mandate was undertaken in which Emergency Departments were to implement processes requiring patients to be discharged or admitted within four hours of presentation. These rules phased in through 2009 in the tertiary hospitals, and then in 2010 in the secondary hospitals.
Of course, with an arbitrary mandate to simply “work faster,” the concerns were that this would have adverse effects on mortality. Rather, the overall mortality of patients admitted through the Emergency Department tended to decrease during this time period. Each of the hospitals spent less time of ED diversion (“access block”) as well.
The article doesn’t mention specifically what process changes were implemented, but it does allude to and likely understates the resistance met while making ED overcrowding a problem for the entire hospital. Authors report that shifting patients out of the Emergency Department led to a greater proportion of the initial investigations being performed on the inpatient wards, leading to some professional stress.
Regardless, this article seems to suggest that it is feasible, in a culture accepting of change in practice pattern, to decrease the amount of time patients spend in the Emergency Department. It also seems to demonstrate it is, at least, potentially safe. That being said, it would be quite a feat to accomplish something similar here in the U.S., given the various warring incentives at work in our highly dysfunctional system.
Emergency department overcrowding, mortality and the 4-hour rule in Western Australia”
www.ncbi.nlm.nih.gov/pubmed/22304606