RT Journal Article
SR Electronic
T1 Performing or not performing: what's in a target?
JF Future Hospital Journal
JO Future Hosp J
FD Royal College of Physicians
SP 167
OP 172
DO 10.7861/futurehosp.4-3-167
VO 4
IS 3
A1 Julie Eatock
A1 Matthew Cooke
A1 Terry P Young
YR 2017
UL http://www.rcpjournals.org/content/4/3/167.abstract
AB This paper analyses how providers have coped with the 4-hour target over the past 7 years. To do this, we used publicly available data from NHS Digital to track how long patients remain in accident and emergency (A&E) departments and their ‘attendance disposal method’. Using this tool, we compared two A&E departments with similar arrival patterns and age profiles and that perform equally well against the target in a specific year. However, these hospitals exhibit very different underlying behaviour. Over 7 years, both exhibit a general increase in length of stay, increasing number of patients being admitted in the 20 minutes preceding the 4-hour target, and rising numbers of patients that breach the target. Despite the two hospitals having similar input profiles there is a 12 percentage point difference in the number of patients who leave the A&E department in the last 20 minutes. This operational information is not visible simply by monitoring the single existing metric. We conclude that the 4-hour target in isolation is an inadequate measure and we reflect on the difference between selecting measures for policy-level review, and for operational management. A link to download the graphs for each A&E in England is available.