No evidence that 4 hour A&E target benefits clinical care, say doctors

Jul 07, 2010

In this week's BMJ, a group of senior doctors say they have no evidence that the four hour A&E target benefits clinical care. They also argue that it has encouraged target led rather than needs led care.

The UK four hour standard for processing patients attending emergency departments was introduced at 90% in 2004 and has sat at 98% since 2005, write Suzanne Mason and colleagues in a letter to the journal.

Last week, this target was relaxed to 95% by the new coalition government.

In 2005, the authors showed that patients admitted to hospital from the emergency department were affected most by a "spike" in activity during the last 20 minutes of the four hours, which affected 12.3% of admitted patients and 3.6% of discharged patients in 2004.

Now they set out to find out whether this spike was still occurring nationally.

They analysed 12.2 million new patient episodes at English emergency departments in 2008-2009. The data show that the spike is still present and larger than in 2004, affecting 30.7% of admitted patients and 10.5% of discharged patients.

"Although many in the specialty of emergency medicine support the benefits that the four hour target has brought, these results suggest that they are not being experienced by all patients, and that processes throughout the hospital and wider healthcare system may not have improved to accommodate it," they say.

"Good evidence based indicators of quality in emergency medicine need development," they add. "We have no evidence that the 98% four hour target benefits clinical care, and our findings suggest that it has encouraged target led rather than needs led care."

Explore further: Exploring 3-D printing to make organs for transplants

add to favorites email to friend print save as pdf

Related Stories

Emergency room waits getting longer

Jan 15, 2008

Emergency room wait times in the United States are getting longer, especially for the severely ill, medical researchers said Tuesday.

Doctors' orders lost in translation

Jul 17, 2008

When patients are discharged from the emergency department, their recovery depends on carefully following the doctors' instructions for their post care at home. Yet a vast majority of patients don't fully understand what ...

CT scans to determine heart disease in the emergency room

Nov 27, 2007

In the future, patients who arrive at a hospital Emergency Department complaining of chest pain may be diagnosed with a sophisticated CT scan. If the diagnosis is negative, the patient can go homeā€”and the total time at ...

Recommended for you

Exploring 3-D printing to make organs for transplants

7 hours ago

Printing whole new organs for transplants sounds like something out of a sci-fi movie, but the real-life budding technology could one day make actual kidneys, livers, hearts and other organs for patients ...

High frequency of potential entrapment gaps in hospital beds

9 hours ago

A survey of beds within a large teaching hospital in Ireland has shown than many of them did not comply with dimensional standards put in place to minimise the risk of entrapment. The report, published online in the journal ...

Key element of CPR missing from guidelines

Jul 29, 2014

Removing the head tilt/chin lift component of rescue breaths from the latest cardiopulmonary resuscitation (CPR) guidelines could be a mistake, according to Queen's University professor Anthony Ho.

Burnout impacts transplant surgeons (w/ Video)

Jul 28, 2014

Despite saving thousands of lives yearly, nearly half of organ transplant surgeons report a low sense of personal accomplishment and 40% feel emotionally exhausted, according to a new national study on transplant surgeon ...

User comments : 0