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 depart ment (ED) have on efficacy, health care quality and efficiency. MATERIAL AND METHOD: Reforms consisted of 50% and 34% increases in structur al and human resources, respectively. Roles of each ED member were redeterm ined, new assistance pathways were implemented, and the relationship betwee n ED and the remaining hospital departments was reassessed. As efficacy mar kers, 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 witho ut having been visited by a physician (IPNV), the percentage of patients wh o 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 dai ly over 3 weeks, before (February 1999) and after (February 2000) the refor ms. Effectiveness was estimated from the ratio P-total/T-esp (E1) and P-tot al/P-esp (E2). Costs were recorded for both periods and a cost-effectivenes s 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 h ealth-care quality markers after the ED reforms. E1 increased by 996% (CI 9 5%: 335% to 1,658%) and E2 increased by 186% (CI 95%: -23% to 395%). Cost-e ffectiveness 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 objectiv e improvement of its efficacy and health-care quality and, consequently, th e service and quality perceived by users improve. Despite the total cost in crease after the ED reforms, efficiency also improves.