Lessons from the 4-hour standard in England for Australia

Forero, Roberto; McDonnell, Geoff D; McCarthy, Sally M; Nugus, Peter; Braithwaite, Jeffrey; Hillman, Kenneth M; Fatovich, Daniel M; Mountain, David; Daly, Frank F; Fitzgerald, Gerard J; Richardson, Drew B

doi:10.5694/j.1326-5377.2011.tb02964.x

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To the Editor: Australia is in the process of making the most important change to its health care system since the implementation of Medicare.1 We agree with Cameron and Cooke that there are important lessons for Australia from the implementation of the 4-hour rule in the United Kingdom.2 As in Robert Zemeckis’s 1985 movie classic, Back to the future, the old question of “If I had the opportunity to do something again, what would I have done differently?” applies.

1 Simpson Centre for Health Services Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW.
2 Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW.
3 Prince of Wales Hospital, Sydney, NSW.
4 Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW.
5 Centre for Clinical Research in Emergency Medicine, University of Western Australia, Perth, WA.
6 Sir Charles Gairdner Hospital and University of Western Australia, Perth, WA.
7 Royal Perth Hospital and University of Western Australia, Perth, WA.
8 Queensland University of Technology, Brisbane, QLD.
9 Canberra Hospital and Australian National University, Canberra, ACT.

Correspondence: r.forero@unsw.edu.au

Competing interests:

David Mountain has received a $10 000 grant from the Department of Health of WA to research a management pathway for chest pain to shorten patient length of stay in the ED. Frank Daly is employed by the Department of Health of WA in the role of Executive Clinical Lead for the WA Four Hour Rule Program. Drew Richardson has received grants from the Australasian College for Emergency Medicine to research crowding of EDs. He has received funding and travel expenses from the Australian Department of Health and Ageing for his participation in the National Emergency Department Project Advisory Committee.

1. Kirby T. Moving Australia’s health-care system into the 21st century. Lancet 2010; 376: 219-220.
2. Cameron PA, Cooke MW. Lessons from the 4-hour standard in England for Australia [editorial]. Med J Aust 2011; 194: 4-5. <MJA full text>
3. United Kingdom Department of Health Urgent and Emergency Care. A&E clinical quality indicators. Data definitions. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122892.pdf (accessed Feb 2011).
4. Forero R, Hillman KM, McCarthy SM, et al. Access block and ED overcrowding. Emerg Med Australas 2010; 22: 119-135.
5. Paul SA, Reddy MC, DeFlitch CJ. A systematic review of simulation studies investigating emergency department overcrowding. Simulation 2010; 86: 559-571.

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Lessons from the 4-hour standard in England for Australia

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