The effects of bonus payments on emergency service performance in Victoria

Objectives To review and analyse the system effects of the Emergency Service Enhancement Program (ESEP): bonus payments made to public hospitals to improve access to care for patients attending emergency departments. Design A review of the first 3 years' performance data, obtained from the Victorian Emergency Department Minimum Dataset (VEMD). Setting 21 public hospital emergency departments in Victoria, Australia (population 4.5 million), with about 700000 patient attendances per year. The ESEP began in April 1995. Main outcome measures The ESEP indicators of emergency department and inpatient bed access: occasions of “ambulance bypass” (emergency department unable to accept patients arriving by ambulance); emergency waiting times for Category 1, 2 and 3 patients (National Triage Scale) compared with agreed national performance thresholds; and “access block” (> 12 hours' waiting time in the emergency department before admission to hospital). Results The number of occasions of ambulance bypass per quarter decreased from 600 in 1994 to fewer than 100 in 1997 (P