Abstract
[Extract]
The National Emergency Access Target (NEAT) has been introduced in Australia and by 2015, 90% of all patients will have to leave the ED within 4 h. The background for the introduction of this target is based on the fact that overcrowding and prolonged ED length of stay for admitted patients is associated with poorer outcomes. These poorer outcomes indicate a suboptimal quality of care.
Quality of care is an important but complex concept, with no universally accepted gold standard and therefore difficult to measure. Quality indicators are often difficult to define and open to interpretation. This leaves us with performance indicators that are easier to measure, but in reality are only surrogate markers for quality. There is a myriad of examples in medicine where surrogate endpoints improved, but where the actual patient‐centred outcomes deteriorated. A famous example is the CAST trial from 1991, where flecainide significantly suppressed the number of ventricular ectopic beats after myocardial infarction. Despite this improvement in the surrogate marker, mortality was significantly greater in the flecainide group. This highlights an important lesson: because something is easy to measure does not make it a relevant (patient‐centred) outcome.
The National Emergency Access Target (NEAT) has been introduced in Australia and by 2015, 90% of all patients will have to leave the ED within 4 h. The background for the introduction of this target is based on the fact that overcrowding and prolonged ED length of stay for admitted patients is associated with poorer outcomes. These poorer outcomes indicate a suboptimal quality of care.
Quality of care is an important but complex concept, with no universally accepted gold standard and therefore difficult to measure. Quality indicators are often difficult to define and open to interpretation. This leaves us with performance indicators that are easier to measure, but in reality are only surrogate markers for quality. There is a myriad of examples in medicine where surrogate endpoints improved, but where the actual patient‐centred outcomes deteriorated. A famous example is the CAST trial from 1991, where flecainide significantly suppressed the number of ventricular ectopic beats after myocardial infarction. Despite this improvement in the surrogate marker, mortality was significantly greater in the flecainide group. This highlights an important lesson: because something is easy to measure does not make it a relevant (patient‐centred) outcome.
| Original language | English |
|---|---|
| Pages (from-to) | 217-218 |
| Number of pages | 2 |
| Journal | EMA - Emergency Medicine Australasia |
| Volume | 26 |
| Issue number | 3 |
| DOIs |
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| Publication status | Published - Jun 2014 |