Evidence map›Paper›PMID 30700302›Full record

ArticleBMC health services research2019

Perceptions and experiences of emergency department staff during the implementation of the four-hour rule/national emergency access target policy in Australia: a qualitative social dynamic perspective.

Roberto Forero, Shizar Nahidi, Josephine de Costa, Daniel Fatovich, Gerry FitzGerald, Sam Toloo, Sally McCarthy, David Mountain, Nick Gibson, Mohammed Mohsin and 1 more

Open access · goldAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
3.1field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 20 citations in OpenAlex.

  1. Article
  2. Co-Design of a Framework for Person-Centred Care at Emergency Department Triage and Waiting Room.Health expectations : an international journal of public participation in health care and health policy · 2025
    Article
  3. Article
  4. Intensive care unit admission from the emergency department in the setting of National Emergency Access Targets.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2023
    Article
  5. Communicating decisions about care with patients and companions in emergency department consultations.Health expectations : an international journal of public participation in health care and health policy · 2022
    Article
  6. Article
  7. Article
  8. Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 7 institutions in 1 country.

Roberto ForeroSimpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia. r.forero@unsw.edu.au.ORCID http://orcid.org/0000-0001-6031-6590
Shizar NahidiSimpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia.
Josephine de CostaSimpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia.
Daniel FatovichDepartment of Emergency Medicine, Royal Perth Hospital, Perth, WA, Australia.
Gerry FitzGeraldSchool of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
Sam TolooSchool of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
Sally McCarthyEmergency Department, Prince of Wales Hospital , Randwick, NSW, Australia.
David MountainDepartment of Emergency Medicine, Sir Charles Gairdner Hospital, Crawley, WA, Australia.
Nick GibsonSchool of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.
Mohammed MohsinPsychiatry Research and Teaching UNit, Liverpool Hospital, NSW Health, Liverpool, NSW, Australia.
Wing Nicola ManSimpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia.
Liverpool Hospital · AUQueensland University of Technology · AUThe University of Western Australia · AUEdith Cowan University · AUIngham Institute · AUThe University of Sydney · AUUNSW Sydney · AU

Funding

ACEM Foundation Cash ContributionDepartment of Health, Government of Western Australia Cash ContributionEmergency Care Institute Cash ContributionNational Health and Medical Research Council APP1029492NSW Agency for Clinical Innovation Cash ContributionNSW Ministry of Health Cash ContributionQueensland Emergency Medicine Research Foundation Cash Contribution
6 · The paper itself

Abstract

backgroundThe Four-Hour Rule or National Emergency Access Target policy (4HR/NEAT) was implemented by Australian State and Federal Governments between 2009 and 2014 to address increased demand, overcrowding and access block (boarding) in Emergency Departments (EDs). This qualitative study aimed to assess the impact of 4HR/NEAT on ED staff attitudes and perceptions. This article is part of a series of manuscripts reporting the results of this project.

methodsThe methodology has been published in this journal. As discussed in the methods paper, we interviewed 119 participants from 16 EDs across New South Wales (NSW), Queensland (QLD), Western Australia (WA) and the Australian Capital Territory (ACT), in 2015-2016. Interviews were recorded, transcribed, imported to NVivo 11 and analysed using content and thematic analysis.

resultsThree key themes emerged: Stress and morale, Intergroup dynamics, and Interaction with patients. These provided insight into the psycho-social dimensions and organisational structure of EDs at the individual, peer-to-peer, inter-departmental, and staff-patient levels.

conclusionFindings provide information on the social interactions associated with the introduction of the 4HR/NEAT policy and the intended and unintended consequences of its implementation across Australia. These themes allowed us to develop several hypotheses about the driving forces behind the social impact of this policy on ED staff and will allow for development of interventions that are rooted in the rich context of the staff's experiences.

Indexed as

Attitude of Health PersonnelAustralian Capital TerritoryEmergency Service, HospitalFemaleHealth PolicyHealth Services AccessibilityHumansInterprofessional RelationsJob SatisfactionMaleMedical Staff, HospitalNew South WalesOccupational StressPerceptionProfessional-Patient RelationsQualitative ResearchAustraliaEmergency departmentFour hour ruleHealth policyNational Emergency Access TargetQualitative researchUnintended consequences

Identifiers

PMID30700302
PMCPMC6354365
OpenAlexW2931717679

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.