Four-hour target in emergency departments

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A four-hour target in emergency departments was introduced by the Department of Health for National Health Service acute hospitals in England. Setting a target that, by 2004, at least 98% of patients attending an A&E department must be seen, treated, admitted or discharged in under four hours. The target was revised by the Department of Health to 95% in June 2010.[1]

Objective[edit]

The UK Labour government had identified a requirement to promote improvements in A&E departments, which had suffered underfunding for a number of years. The target, accompanied by extra financial support, was a key plan to achieve the improvements.

Results[edit]

Tony Blair felt the targets had been successful in achieving their aim. "We feel, and maybe we are wrong, that one way we've managed to do that promote improvements in A&E is by setting a clear target".[2]

Forty-eight per cent of departments said they did not meet the target for the period ending 31 December 2004.[3] Government figures show that in 2005-06, 98.2% of patients were seen, diagnosed and treated within four hours of their arrival at A&E, the first full financial year in which this has happened.[4]

Missing the target[edit]

According to the BMA[3] the main reasons for not reaching this target are:

  • Not enough inpatient beds
  • Delayed discharges
  • Delay in accessing specialist opinion
  • Not enough nurses
  • Not enough middle grade doctors
  • Department too small
  • Delay in accessing diagnostic services

Exceptions[edit]

The original target was set at 100%, but lowered to reflect clinical concerns that there will always be patients who need to spend slightly longer in A&E, under observation.[5]

The target was further moved to 95% of patients within 4 hours in 2010 as a result of the coalition's claims that 98% was not clinically justified.[6]

Pressure[edit]

Even though exceptions are allowed to the targets, concerns have been raised that the target has put pressure on A&E staff to compromise patient care. A significant proportion (90%) of A&E consultants welcomed the 4 hour target in a study but felt that 98% was too high a target.[2]

References[edit]