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Related Experiment Videos

Performing or not performing: what's in a target?

Julie Eatock1, Matthew Cooke2, Terry P Young1

  • 1Brunel University London, Uxbridge, UK.

Future Healthcare Journal
|May 18, 2019
PubMed
Summary

The 4-hour accident and emergency (A&E) target is an inadequate performance measure. Analysis reveals significant differences in patient flow and target breaches between A&E departments, even those with similar patient profiles.

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Area of Science:

  • Healthcare Management
  • Health Services Research
  • Public Health Policy

Background:

  • The 4-hour target for accident and emergency (A&E) departments is a key performance indicator in healthcare systems.
  • Providers have faced challenges in meeting this target over recent years, necessitating analysis of their coping strategies.
  • Existing performance metrics may not fully capture the operational complexities within A&E departments.

Purpose of the Study:

  • To analyze how healthcare providers have managed the 4-hour A&E target over a 7-year period.
  • To compare the underlying operational behaviors of two A&E departments with similar patient profiles and target performance.
  • To evaluate the adequacy of the 4-hour target as a standalone performance metric.

Main Methods:

  • Utilized publicly available data from NHS Digital, focusing on patient length of stay in A&E and attendance disposal methods.
Keywords:
4-hour targetA&Eanalysishospital

Related Experiment Videos

  • Compared two A&E departments with similar patient arrival patterns and age demographics, performing comparably against the 4-hour target.
  • Analyzed trends over 7 years, including length of stay, admissions preceding the 4-hour mark, and target breaches.

    • Main Results:

    • Both analyzed A&E departments showed increasing length of stay, admissions in the 20 minutes before the 4-hour target, and rising target breaches over 7 years.
    • A significant 12 percentage point difference was observed in the proportion of patients leaving A&E within the last 20 minutes, despite similar input profiles.
    • This operational detail regarding patient flow within the final 20 minutes is not captured by the single 4-hour target metric.

    Conclusions:

    • The 4-hour target, when used in isolation, is an insufficient measure for evaluating A&E performance and operational efficiency.
    • There is a critical distinction between metrics suitable for policy-level review and those required for effective operational management.
    • Further investigation into granular operational data is necessary to understand and improve A&E performance beyond the 4-hour target.