Bittersweet NEAT (#FOAMed)
Discussion on the future of the National Emergency Access Target (NEAT) is timely given ACEM’s concerns (ACEM media release May 2014) over the recent Australian Federal Government’s budget announcements, which includes the scrapping of the National Partnership Agreement for Improving Public Hospitals.
Dr Gerben Keijzers (@GerbenGerbs) in his commentary argues that there needs to be a ‘sweet spot’ for NEAT, as patients should not be in the ED for prolonged times but some should not be ‘shipped out’ just to meet a time target. Quality of care is of upmost importance but is complex and difficult to measure. Performance indicators, such as NEAT, are easier to measure but are, at best, only surrogate markers of quality. A key issue is that the parameters of the current NEAT are not evidence-based.
This lack of evidence-base for NEAT is also a concern for Dr David Green in his personal view. While it is acknowledged that NEAT has assisted with ED overcrowding, Green argues that the current target is resulting in ED doctors spending less time with patients and complex cases being diverted from ED. This has risks for maintaining the ED workforce, quality of registrar training and standards of patient care. Quality of patient care must be prioritised while ensuring access to care is maintained. This requires more sophisticated measurements of the quality of emergency medical care.
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