State Government's four-hour target reduces patient waiting times

Thirty per cent more patients arriving at Perth's major teaching hospital's emergency departments (ED) are being seen, admitted, discharged or transferred within four hours compared to the same time the previous year.

There have also been considerable improvements in ambulance ramping and access block, with patients waiting shorter times before being moved to a hospital bed.

The positive results were made public today by Health Minister Kim Hames with the release of interim figures for the Liberal-National Government's nation-leading Four Hour Rule Program which is being implemented across West Australian hospitals to improve the way patients received unplanned or emergency care.

He said last week's announcement to roll-out this innovative program nationally, showed the Federal Government was following WA's lead. Last year, 470,000 people attended emergency departments in the metropolitan area.

"These results, after just one year under the four-hour rule, are proof that through innovation, good amanagement and good staff, Western Australia has one of the best health systems in the nation. We are years ahead of the pack, with the Federal Government's plan not due to be finalised until 2014.

"This was a key health election commitment for this Government and we are already seeing benefits.

"Waiting times at WA's major emergency departments are now among Australia's best and patient safety and quality of care had been maintained since the program began.

"These gains have been made despite the fact the demand on our EDs continues to grow with attendances rising by more than 8.4 per cent increase in the past financial year.

"There is still work to be done, but these figures show improving performance in almost every area.

"At a time when the demand on our public hospital is increasing, it is evidence of how much work is being done."

Royal Perth (RPH), Sir Charles Gairdner (SCGH), Princess Margaret (PMH) and Fremantle hospitals were the first WA hospitals to start the Four Hour Rule Program in April 2009.

He said while most of the hospitals had not yet maintained the April 14 interim target of 85 per cent; improvements since the program had been dramatic and were continuing an upward trend.

Preliminary figures showed that Princess Margaret, Royal Perth and Fremantle hospitals hit the 85 per cent target on 28, three and two days respectively in the past four weeks.

Early results for April showed that, on average, RPH was tracking at 75.1 per cent (up 20 per cent) SCGH at 57.1 per cent (up 13 per cent) and Fremantle Hospital at 79.6 per cent (up 30 per cent) from the same time the previous year.

PMH was tracking above the 85 per cent interim target at 93 per cent and had consistently done so since September 2009.  It had hit the end target of 98 per cent once already this month.

The latest data for April 2010 showed access block had reduced at all teaching hospitals from April last year when the program began.

At RPH, access block decreased from 30 to 16 per cent, SCGH from 31 to 17 per cent, Fremantle Hospital from 43 to 16 per cent and PMH from seven to four per cent.

In April, ambulance ramping reduced by more than 85 hours across the sites compared to the same time the previous year.

WA has invested more than $20million from funds allocated to improving ED capacity to implement the Four Hour Rule Program across two years.

The Minister said the progress towards the key target of 98 per cent in April 2011 was expected to gain momentum as redesign projects continued to show results.

"Staff are rolling-out a range of initiatives which will benefit patients and continue to improve waiting times," he said.

"We have set high targets because we want to encourage staff to be innovative and find sustainable solutions.

"If it was an easy target, we would not have seen such major gains."

Dr Hames said the Four Hour Rule Program was a huge undertaking that required major changes to the way the public system operated which was why the program was being rolled-out over two years.

The Four Hour Rule Program is being introduced in three stages.  Stage Two sites commenced in October 2009 and the official launch date for Stage Three sites is

May 17, 2010.

Programs undertaken at the teaching hospitals to decrease patient waiting times include:

Royal Perth Hospital:

·             realigned the hospital into 'home wards', designed to facilitate stronger teamwork between staff, led by a senior nurse.

·             reduced the number of outlying patients in hospital beds away from the teams primarily responsible for their care.

·             established team-based care in the ED where senior doctors work with a junior doctor and nurse to streamline treatment and reduce waiting times.

·             employed an ED operations manager to facilitate patient flow through the ED.

Sir Charles Gairdner Hospital:

·             reviewed patient admission procedures to fast-track admissions for patients on to the wards and to reduce waiting times at EDs.

·             established an Emergency Decisions Unit to allow patients who require short-term admission to be cared for within the ED to prevent short duration ward transfers.

·             revamped discharge processes so more beds are available on the wards for new admissions.

·             approved plans to build a satellite pharmacy, enabling pharmacists to fill simple discharge scripts, reducing the time a patient waits for medication.

Fremantle Hospital:

·             extended services at a transit lounge for patients who were waiting discharge to help free-up hospital beds

·             established dedicated surgical assessment, medical assessment and clinical decisions units to admit, treat and discharge patients earlier, reduce their average length of stay and free-up beds in the ED.

·             appointed an ED Navigator/Flow Coordinator - a senior nurse whose job it is to facilitate patient flow through the ED.

Princess Margaret Hospital:

·             revised bed management processes and clinical procedures to reduce delays for patients admitted through the ED to hospital wards.

·             started a program to facilitate earlier patient discharge which includes displaying estimated discharge dates and discussing this daily with families from the time a patient is admitted.

Minister's office - 9222 8788

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