Is the rise in emergency admissions linked to A&E targets?

The four-hour A&E target set by the Department of Health required 98 per cent of patients attending A&E departments to be seen, treated, admitted or discharged in under four hours by 2004. Hover over the time points for details of individual measures, and click on the key below the x axis to remove individual lines from the chart.

It has been suggested that Trusts might have admitted patients for ‘observation’ when close to breaching the four-hour waiting target, resulting in the patient being admitted for less than one day (effectively a few hours) and discharged as soon as they could be assessed properly and treated.

This chart tracks the parallel changes in the number of four-hour target breaches and short-stay emergency admissions in England from 2002/03 onwards. It shows the actual number of attendees waiting more than four hours (breaches) or admitted as a zero bed-day stay, as well as the percentage of people attending A&E seen within four hours (target achievement). This assumes that all admissions happen before a patient has breached the four-hour target waiting time.

Nationally, and in most Trusts, the pattern of admissions does not suggest a link between breaches and the rise in short-stay admissions. However, there are some Trusts where there is an apparent substitution between zero bed-day admissions and breaches, where the number of combined events is relatively steady but the number of breaches falls away drastically. There could be other explanations for this behaviour.

This analysis was published in July 2010 in the Nuffield Trust report: Trends in emergency admissions in England 2004-2009: is greater efficiency breeding inefficiency? The report examined in detail the rise in emergency admissions in England from 2004/05 to 2008/09. It revealed the number of emergency admissions across England had risen by approximately 11.8 per cent – or by around 1.35million extra admissions.

Find out more about our work in this area by visiting the Understanding trends in emergency care project page.