Reform of an emergency department and its impact on health care quality and cost-effectiveness

BACKGROUND: TO determine the effects that the reform of an emergency department (ED) have on efficacy, health care quality and efficiency. MATERIAL AND METHOD: Reforms consisted of 50% and 34% increases in structural and human resources, respectively. Roles of each ED member were redetermined, new assistance pathways were implemented, and the relationship between ED and the remaining hospital departments was reassessed. As efficacy markers, we determined the number of patients waiting to be attended (P-esp), the waiting time of patients to receive medical assistance (T-esp), and the total waiting time of patients staying in the ED (T-total). As health-care quality markers, we determined the percentage of patients leaving ED without having been visited by a physician (IPNV), the percentage of patients who were visited again (IPR), and the percentage of mortality (IPF). We also quantified the number of visits to the ED. All these data were obtained daily over 3 weeks, before (February 1999) and after (February 2000) the reforms. Effectiveness was estimated from the ratio P-total/T-esp (E1) and P-total/P-esp (E2). Costs were recorded for both periods and a cost-effectiveness analysis was performed to study the efficiency. RESULTS: In 2000, the number of visits increased by +12% (CI 95%: 2% to 22%). Despite this increase, we observed an improvement of most efficacy and health-care quality markers after the ED reforms. E1 increased by 996% (CI 95%: 335% to 1,658%) and E2 increased by 186% (CI 95%: -23% to 395%). Cost-effectiveness analysis showed 70% (CI 95%: 33% to 107%) and 56% (CI 95%: 18% to 94%) increases regarding E1 and E2, respectively, after the reforms. CONCLUSIONS: Providing ED with the necessary resources leads to an objective improvement of its efficacy and health-care quality and, consequently, the service and quality perceived by users improve. Despite the total cost increase after the ED reforms, efficiency also improves.