The 4-Hour Rule: An ENT Perspective

Abstract

Objectives:

The pervasive theme in Western Australian medicine in 2011/2012 was the newly introduced 4-hour rule in emergency departments. This article approaches the various issues and problems from an ear, nose, and throat (ENT) perspective, with subsequent recommendations.

Methods:

We performed a retrospective audit looking at the most commonn ENT diagnoses according to the ICD-10-AM classification: acute pharyngitis, streptococcal tonsillitis, acute tonsillitis, and peritonsillar abscess. Patients looked at included those who presented 6 months before and after the 4-hour rule implementation.

Results:

We found a decreased diagnostic accuracy (41.2% vs 28.6%), reduced intravenous hydration commencement (94.1% vs 64.3%), and reduced intravenous antibiotics commencement (70.6% vs 50.0%).

Conclusions:

Although positivity has been seen within certain aspects of patient outcomes since the introduction of the 4-hour rule, certain inherent issues must be acknowledged. Recommendations and modifications have been suggested as possible alternatives.