Intended for healthcare professionals


Admissions from emergency departments rise as four hour target approaches

BMJ 2009; 339 doi: (Published 19 November 2009) Cite this as: BMJ 2009;339:b4931
  1. Helen Mooney
  1. 1London

    The number of patients leaving emergency departments each minute rises with the approach of the government’s four hour maximum waiting time target, research has shown. The rise is especially marked in the 10 minutes before the deadline expires, with 6% of all patients attending emergency departments in England being seen and treated in this time.

    The research, published by the NHS Information Centre on 18 November, also shows that the percentage of patients leaving emergency departments who are admitted to hospital rises markedly in the last 10 minutes before the four hour cut-off, with 66% transferred to inpatient wards compared with 21% overall.

    The analysis is based on 11.5 million attendances at emergency departments in England, including minor injuries units and walk-in centres, between April 2007 to March 2008.

    It shows that overall three quarters of patients seen in emergency departments in England were treated or admitted to hospital within three hours of arriving, an hour ahead of the government’s maximum waiting time target.

    On average 41% of all emergency patients were discharged with no follow-up required, and a further 21% were admitted to hospital.

    Tim Straughan, chief executive of the NHS Information Centre, said, “This report gives a valuable, minute by minute insight into patients’ experience of A&E [accident and emergency] services and highlights a marked variation in both the speed of care and the destination of patients when they leave A&E.

    “With data at individual trust level, A&E departments may want to compare how their approach varies with others as there are marked differences from place to place.”

    The health minister Mike O’Brien said, “Patients tell us the time spent in A&E matters to them, which is why A&E waiting times continue to be a target.

    “During the last quarter, over five million people attended A&E with the four hour standard still being met. This is good news for patients who no longer have to spend several hours or even days in A&E. Meeting the standard does not mean that the quality of care is compromised. We have always made it clear that quality of care and clinical need must come first, and we expect trusts to ensure that patient safety is their first priority.”

    An interactive tool released by the NHS Information Centre enables providers’ local data to be compared.


    Cite this as: BMJ 2009;339:b4931


    • The report, Accident and Emergency: Patient journey—Further Analysis of the Published 2007/08 A&E Hospital Episodes Statistics Data (Experimental Statistics), and the interactive comparator tool are at