Ellen J. Weber

Ellen J. Weber, MD, is a professor emeritus of emergency medicine at the University of California, San Francisco. Her research interests include emergency-department crowding, utilization, triage, and quality of care.

Weber and colleagues examined whether England’s four-hour emergency-department target coincided with changes in care quality and resource use. Their 2012 retrospective study analyzed visits at 15 selected emergency departments. It found no apparent deterioration in the safety and quality outcomes it measured, including deaths in the emergency department and return visits within a week, and little overall effect on test use.

The study offers an important qualification for discussions of narrow performance measures: a time target should not be assumed to cause harm simply because it focuses attention on one part of a care pathway. Its selected sites and outcomes also cannot establish that the target had no unintended effects elsewhere.