NEAT - The Basics

What is NEAT?

  • NEAT stands for National Emergency Access Target
  • By 2015, 90% of all patients will leave the Emergency Department (ED) within 4 hours:
    • Discharged
    • Admitted to hospital
    • Transferred to another hospital for treatment
  • The target does not overrule clinical judgement
  • The target is being staged incrementally
  • It applies only to hospitals that currently report the National ED Data Set, NSW Health, February 2012
  • All ED patients are included in the target
  • Overcrowding and prolonged LOS in ED for admitted patients is associated with poorer outcomes [1][2][3] . Access block has also resulted in non-admitted patients remaining in ED for longer than necessary reducing access for new patients presenting at the ED, and delayed ambulance offloads.

What are the principles of NEAT?

  • To drive clinical service redesign
  • It is a whole hospital change not just ED
  • It requires Executive engagement and leadership at both hospital and LHD level
  • The majority of process change needs to occur at the ‘back end’ rather than in the ED but EDs will benefit from reviewing existing processes and MOC for efficiency
  • The target has been reduced to 90% to reflect the ‘clinically appropriate’ patients. 
  • It applies to patients in all triage categories
  • $96.9 million will be provided nationally from 2010-11 to 2012-13 for facilitation funding
  • $63.6 million will be provided nationally from 2012-11 to 2015-16 for reward funding which will be conditional on meeting the required performance (based on COAG review and decision)

When does the clock start and stop?

NEAT is measured from first patient contact in the ED, and should be recorded by the clinician carrying out the initial triage/assessment or ED reception, whichever is earlier. The clock stops when the patient physically leaves the ED whether they are admitted, transferred, or discharged home.

Triage should occur as soon as possible after a patient presents to an emergency department, but where clerical staff contact comes first this is when the clock starts.

The NSW Ministry of Health have produced a visual ED data points pathway that highlights when the clock starts and stops for NEAT.

NEAT target in NSW

The following are the NEAT targets for NSW:

  • 1 January 2012 - 31 December 2012 - 69%
  • 1 January 2013 - 31 December 2013 - 71%
  • 1 January 2014 - 31 December 2014 - 81%
  • 1 January 2015 - 31 December 2015 - 90%

For further information please visit the NSW Health NEAT page

FAQs

Did WA find that patient outcomes were worse with the introduction of the NEAT target?

A recent study[5] has found that Introduction of the 4-hour rule in WA in fact led to a reversal of overcrowding in three tertiary hospital EDs that coincided with a significant fall in the overall mortality rate in tertiary hospital data combined and in two of the three individual hospitals.

Why is Australia introducing the ‘4 hour rule’ when the UK have abolished this?

The UK has not abolished the 4-hour target, but has reduced the performance threshold from 98% of ED patients to 95% of ED patients, and has introduced a suite of additional clinical quality indicators. There are now 8 clinical quality indicators, a number of which measure the patient’s time in the ED[6].



[1] Richardson DB ‘ Increase in patient mortality at 10 days associated with emergency department overcrowding’. Medical Journal of Australia 2006, 184, 213-216

[2] Sprivulis PC., Da Silva JA., Jacobs IG., Frazer AR., Jelinek GA ‘The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments’. Medical Journal of Australia 2006, 184, 208-212

[3] Forero R., Hillman K., McCarthy S., Fatovich D., Joseph A., Richardson DW ‘Access block and Emergency Department Overcrowding’. Emergency Medicine Australasia 2010, 22, 119-135

[4] Note: Baseline is 2009–10 performance levels, without “exclusions”. The targets increase linearly between the baseline and 2015. Targets are the average performance over the calendar year. Rewards apply to 2012 to 2015. The baseline does not represent similar hospitals in all states and territories as it includes all hospitals that currently report to the Non-Admitted Patient Emergency Department Care National Minimum Dataset—it is assumed to include all Peer Group A and B hospitals with emergency departments and it is noted that additional hospitals may be included over time. Click here for the full guidance.

[5] Geelhoed G. and de Klerk N. ‘Emergency department overcrowding, mortality and the 4-hour rule in Western Australia’ MJA 2012; 196 (2): 122-126

[6] ‘A&E clinical quality indicators: Implementation guidance and data definitions’ Department of Health, UK, Dec 2010 available here.

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