Emergency department overcrowding and mortality after the introduction of the 4-hour rule in Western Australia

Toh, Dylan J; Thompson, Campbell H; Thomas, Josephine S; Faunt, Jeffrey

doi:10.5694/mja12.10304

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To the Editor: We read with interest the article by Geelhoed and de Klerk1 regarding the mortality benefits of a policy that ensures high numbers of patients are admitted to hospital within 4 hours of arrival at an emergency department (ED). The proof of improved performance following service intervention within a complex institution requires careful consideration. We offer an alternative interpretation of their data.

1 Royal Adelaide Hospital, Adelaide, SA.
2 University of Adelaide, Adelaide, SA.

Correspondence: dylan.toh@health.sa.gov.au

Competing interests:

No relevant disclosures.

1. Geelhoed GC, de Klerk NH. Emergency department overcrowding, mortality and the 4-hour rule in Western Australia. Med J Aust 2012; 196: 122-126. <MJA full text>
2. Li JYZ, Yong TY, Bennett DM, et al. Outcomes of establishing an acute assessment unit in the general medical service of a tertiary teaching hospital. Med J Aust 2010; 192: 384-387. <MJA full text>
3. Yong TY, Li JY, et al. The selection of acute medical admissions for a short stay unit. Intern Emerg Med 2011: 321-327.

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