Understanding ED performance after the implementation of activity‐based funding

Objective: The aim of this study was to describe emergency department (ED) activities and staffing after the introduction of activity‐based funding (ABF) to highlight the challenges of new funding arrangements and their implementation. Methods: A retrospective study of public hospital EDs in Queensland, Australia, was undertaken for 2013‐2014. The ED and hospital characteristics are described to evaluate the alignment between activity and resourcing levels and their impact on performance. Results: Twenty EDs participated (74% response rate). Weighted activity units (WAUs) and nursing staff varied based on hospital type and size. Larger hospital EDs had on average 9076 WAUs and 13 full time equivalent (FTE) nursing staff per 1000 WAUs; smaller EDs had on average 4587 WAUs and 10.3 FTE nursing staff per 1000 WAUs. Medical staff was relatively consistent (8.1‐8.7 FTE per 1000 WAUs). The proportion of patients admitted, discharged, or transferred within 4 hours ranged from 73% to 79%. The ED medical and nursing staffing numbers did not correlate with the 4‐hour performance. Conclusion: Substantial variation exists across Queensland EDs when resourcing service delivery in an activity‐based funding environment. Historical inequity persists in the staffing profiles for regional and outer metropolitan departments. The lack of association between resourcing and performance metrics provides opportunity for further investigation of efficient models of care.