Objectives: To review and analyse the system effects of the Emergency Servi
ce Enhancement Program (ESEP): bonus payments made to public hospitals to i
mprove access to care for patients attending emergency departments.
Design: A review of the first 3 years' performance data, obtained from the
Victorian Emergency Department Minimum Dataset (VEMD).
Setting: 21 public hospital emergency departments in Victoria, Australia (p
opulation 4.5 million), with about 700 000 patient attendances per year. Th
e ESEP began in April 1995.
Main outcome measures: The ESEP indicators of emergency department and inpa
tient bed access: occasions of "ambulance bypass" (emergency department una
ble to accept patients arriving by ambulance); emergency waiting times for
Category 1, 2 and 3 patients (National Triage Scale) compared with agreed n
ational performance thresholds; and "access block" (>12 hours' waiting time
in the emergency department before admission to hospital).
Results: The number of occasions of ambulance bypass per quarter decreased
from 600 in 1994 to fewer than 100 in 1997 (P < 0.001). Despite an increase
d proportion of patient encounters in triage categories 1, 2 and 3 (31% v.
23%), zero waiting times for Category 1 patients were consistently adhered
to, and adherence to waiting time thresholds for Category 2 and 3 patients
improved significantly (P < 0.001, R-2 = 0.74; and P < 0.035, R-2 = 0.37, r
espectively), particularly for Category 2 patients. The number of patients
waiting longer than 12 hours in emergency departments decreased nonsignific
antly (P = 0.3, R-2 = 0.1).
Conclusion: Our results show that the ESEP has produced sustained improveme
nts in all the indicators linked with bonus payments.