Forero Roberto, Nahidi Shizar, de Costa Josephine, Fatovich Daniel, FitzGerald Gerry, Toloo Sam, McCarthy Sally, Mountain David, Gibson Nick, Mohsin Mohammed, Man Wing Nicola
Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia.
Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW, Australia.
BMC Health Serv Res. 2019 Jan 30;19(1):82. doi: 10.1186/s12913-019-3877-8.
The 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.
The 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.
Three 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.
Findings 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.
2009年至2014年间，澳大利亚州和联邦政府实施了“四小时规则”或国家紧急就诊目标政策（4HR/NEAT），以应对急诊科（ED）需求增加、过度拥挤和就诊受阻（滞留）的问题。这项定性研究旨在评估4HR/NEAT对急诊科工作人员态度和看法的影响。本文是一系列报告该项目结果的手稿的一部分。
该方法已在本期刊发表。如方法论文中所讨论的，我们在2015年至2016年期间采访了新南威尔士州（NSW）、昆士兰州（QLD）、西澳大利亚州（WA）和澳大利亚首都直辖区（ACT）16个急诊科的119名参与者。访谈进行了录音、转录，导入NVivo 11并使用内容和主题分析进行分析。
出现了三个关键主题：压力与士气、群体间动态以及与患者的互动。这些主题从个人、同事之间、部门间以及医护人员与患者层面，深入了解了急诊科的心理社会层面和组织结构。
研究结果提供了与引入4HR/NEAT政策相关的社会互动信息，以及该政策在澳大利亚实施的预期和非预期后果。这些主题使我们能够对该政策对急诊科工作人员社会影响背后的驱动力提出几个假设，并有助于制定基于工作人员丰富经验背景的干预措施。
