Introduction of such a rule has several implications, both positive and negative, both of which will be discussed in this essay.
The main positive outcome of this rule is formal addressing of the established "access block"of eight hours, which was a burden on the emergency departments and had adverse impact on the care of the patient. Thus, the new "access block" standard is four hours and this is enforced with high level of compliance, thereby solving the access block problem. Implementation of the rule forces hospital administrations to take responsibility for the access block problem. Also, ramifications pertaining to patient flow is beyond only ED problem and the hospital gets involved in it. Another major advantage of this rule is that it forces the staff to assess and manage patients at an early stage, thus enhancing the role of clinical judgment, without merely depending on laboratory diagnosis (Cadogan, 2009).
The four hour rule has some negative effects too. It causes increased stress because of increased number of after hour shifts, 24- hour emergency consultant cover and increase in weekend shifts. Such stress, without punitive penalties can lead to gaming of figures, facts and flow of patients. The stress can also cause reduction in the standard of care delivered in the emergency room. Also, the autonomy of the emergency physician can get denuded which can in turn impact the patients negatively. The rule increases the propensity for adverse patient outcomes and here are high chances for the patients to get discharged early without a proper diagnosis. Some experts opine that excellence in patient flow will be rewarded than appropriate patient care (Cadogan,