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Understanding ED performance after the implementation of activity-based funding.

Ghasem-Sam Toloo1, John Burke1,2,3, Julia Crilly4,5

  • 1School of Public Health and Social Work & Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.

The International Journal of Health Planning and Management
|December 2, 2017
PubMed
Summary

Activity-based funding (ABF) in emergency departments (EDs) shows significant variation in staffing and resources. Current staffing levels do not correlate with 4-hour performance metrics, indicating potential inefficiencies.

Keywords:
activity-based fundingemergency departmentmedical workforcemodels of carenursing workforce

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Area of Science:

  • Health Services Research
  • Hospital Administration
  • Emergency Medicine

Background:

  • Activity-based funding (ABF) is a payment model for healthcare services.
  • Implementing new funding models like ABF presents challenges in resource allocation and service delivery.
  • Understanding the impact of ABF on emergency department (ED) operations is crucial for healthcare system efficiency.

Purpose of the Study:

  • To describe emergency department (ED) activities and staffing post-introduction of activity-based funding (ABF).
  • To identify challenges associated with new funding arrangements and their implementation in Australian public hospitals.
  • To evaluate the alignment between ED activity, resourcing, and performance.

Main Methods:

  • Retrospective study of public hospital EDs in Queensland, Australia (2013-2014).
  • Description of ED and hospital characteristics.
  • Analysis of weighted activity units (WAUs), nursing and medical staffing (FTE per 1000 WAUs), and 4-hour performance metrics.

Main Results:

  • Twenty EDs participated, with variations in WAUs and nursing staff per WAU by hospital type and size.
  • Larger EDs had more WAUs and higher nursing FTE per 1000 WAUs compared to smaller EDs.
  • No correlation was found between ED medical and nursing staffing numbers and 4-hour patient throughput performance.

Conclusions:

  • Significant variation exists in ED resourcing within Queensland's ABF environment.
  • Persistent historical inequities in staffing profiles for regional and outer metropolitan departments were observed.
  • The lack of association between resourcing and performance suggests opportunities for investigating more efficient models of care.