Lay summary
The problem of overcrowding in emergency departments (ED) in New Zealand has been a conundrum for more than 30 years. In 2009, the shorter stay target was introduced as a way of improving the patient flow and therefore reducing the level of overcrowding. This target says that 95% of all ED patients should be admitted, discharged, or transferred within six hours. The target has been reasonably successful, but there is mounting evidence that it might be possible to do better. The UK has recently moved away from their 4-hour stay target. Evidence shows that although the target is largely achieved through desired actions, sometimes there are issues of gaming the target and effort substitution. Further, the target has now been in place for over 10 years, so the process improvement benefits associated with its introduction have largely been achieved. This research seeks to identify opportunities for improving the target.