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.
Downing
A
A
Department of Public Health and Epidemiology, University of Birmingham, Edgbaston B15 2TT. a.downing@bham.ac.uk
Wilson
R C
RC
Cooke
M W
MW
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