Which patients spend more than 4 hours in the Accident and Emergency department?
OBJECTIVE
The NHS Plan has a target that no patient should spend longer than 4 hours in Accident and Emergency (A & E) by the end of 2004. The aim of this study is to describe the attendance characteristics of patients spending less than and more than 4 hours total time in A & E.


METHODS
Data were collected from 10 A & E departments in the West Midlands NHS region for the period 1 April 2001 to 31 March 2002. Patients were split into three groups; those spending less than 4 hours, between 4 and 8 hours and over 8 hours in A & E. The groups were compared in terms of their attendance characteristics, these being demography, temporal patterns, arrival mode and disposal. The data were also entered into a multinomial logistic regression using SPSS.


RESULTS
Overall, 83.0 per cent (range 76.7 - 94.0 per cent) of patients spent less than 4 hours in A & E ; 3.6% per cent (range 0.3-8.6 per cent) spent longer than 8 hours in A & E. The risk factors for spending over 4 hours in A & E were requiring admission, arriving by ambulance, arriving during the night, increasing age and higher levels of deprivation. Being admitted had the greatest effect on time spent in A & E, with a patient being 2.64 times more likely to spend 4-8 hours and 4.84 times more likely to spend over 8 hours in the department.


CONCLUSIONS
This study points to admission and service provision at night as factors leading to long periods in A & E. However, these results can only act as a guide as the problems are different in different Trusts and each should analyse their problem before taking action.
Department of Public Health and Epidemiology, University of Birmingham, Edgbaston B15 2TT. a.downing@bham.ac.uk
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Downing
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Wilson
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Cooke
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011159:Population Surveillance; D012307:Risk Factors; D013222:State Medicine / Q000592:standards; D013996:Time and Motion Studies; D014850:Waiting Lists