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Treatment targets in emergency departments: nurses’ views of how they affect clinical practice

Hoyle, Louise; Grant, Aimee

Authors

Louise Hoyle

Aimee Grant



Abstract

Aims and objectives. To understand nurses’ views and experiences of four hour treatment targets in the emergency department and how this impacts clinical decision making throughout acute secondary care hospitals.
Background. In many countries national treatment targets in the emergency department have been introduced. However, research and a recent enquiry into poor clinical care in one hospital in the United Kingdom have highlighted that patient care may be compromised by the need to meet these targets.
Design. Qualitative descriptive study as part of a case study approach.
Methods. Semi-structured interviews with 31 nurses working in UK secondary care hospitals which had an emergency department. Nurses were purposively sampled from three specialties: emergency arenas (emergency department, n=5; medical assessment n=4 surgical receiving n=2) (n=11), surgical wards (n=11) and medical wards (n=9).
Results. Nurses in emergency arenas reported considerable burden, in terms of a very high workload and pressure from senior staff to meet the target. This had a negative impact on patient care for the majority of patients, excluding the most sick, who emergency arena nurses reported they ensured were treated appropriately, regardless of breaching treatment targets. Around half of the nurses working outside emergency arenas felt pressure and amended their work practices to enable colleagues in emergency arenas to meet treatment targets.
Conclusions. Four hour targets were not viewed as clinically helpful by the majority of nurses, some of whom questioned their appropriateness for patient care.

Journal Article Type Article
Acceptance Date Feb 1, 2015
Online Publication Date Apr 7, 2015
Publication Date 2015-08
Deposit Date Apr 28, 2015
Publicly Available Date Apr 28, 2015
Journal Journal of Clinical Nursing
Print ISSN 0962-1067
Electronic ISSN 1365-2702
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 24
Issue 15-16
Pages 2211-2218
DOI https://doi.org/10.1111/jocn.12835
Keywords General Nursing; General Medicine
Public URL http://researchrepository.napier.ac.uk/id/eprint/7898
Publisher URL http://dx.doi.org/10.1111/jocn.12835
Contract Date Apr 28, 2015