• Michael M Dinh, Timothy C Green, Kendall J Bein, Serigne Lo, Aaron Jones, and Terence Johnson.
• Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
• Emerg Med Australas. 2015 Aug 1;27(4):317-22.

ObjectiveThe objective was to evaluate the impact of an ED clinical redesign project that involved team-based care and early senior assessment on hospital performance.MethodsThis was an interrupted time series analysis performed using daily hospital performance data 6 months before and 8 months after the implementation of the clinical redesign intervention that involved Emergency Consultant-led team-based care, redistribution of ED beds and implementation of a senior nursing coordination roles in the ED. The primary outcome was the daily National Emergency Access Target (NEAT) performance (proportion of total daily ED presentations that were admitted to an inpatient ward or discharged from ED within 4 h of arrival). Secondary outcomes were daily ALOS in ED, inpatient Clinical Emergency Response System (CERS) calls and hospital mortality. Autoregressive Integrated Moving Average analysis was used to model NEAT performance. Hospital mortality was modelled using negative binomial regression.ResultsAfter adjusting for patient volume, inpatient admissions, ambulance, hospital occupancy, weekends ED Consultant numbers, weekends and underlying trends, there was a 17% improvement in NEAT associated with the post-intervention period (95% CI 12, 19% P < 0.001). There was no change in the number of CERS calls and the median daily hospital mortality rate reduced from 1.04% to 0.96% (P = 0.025).ConclusionAn ED-focused clinical redesign project was associated with a 17% improvement in NEAT performance with no evidence of an increase in clinical deterioration on inpatient wards and evidence for an improvement in hospital mortality.© 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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