International nursingAttempting to Reduce the Maximum Emergency Waiting Time to 4 Hours in England: Was the Initiative Successful?☆,★
Section snippets
Background/Context
In 2001 the Department of Health introduced an initiative to limit the standard waiting time in the emergency department to decrease time to treatment and enhance patient experience. The introduction of a 4-hour operational standard waiting time was implemented, but was it successful and what were the implications for staff and patients?
The NHS Plan proposed that “by 2004 no-one should be waiting more than four hours in accident and emergency from arrival to admission, transfer or discharge.”2
New Ways of Working
“See and treat” is a system where senior clinicians assess and manage patients as they arrive. This is one of the key innovations that have resulted in a better experience for patients attending the emergency department with minor illness and injury while simultaneously helping staff to manage their workloads.10 Campaigns promoting appropriate use of health services (Figure1, Figure2) and promoting minor-injury units, primary care physicians, and pharmacies as alternatives to the emergency
The Future: Clinical Quality Indicators
After the change in government in May 2010, there have been new proposals for ED targets. The new government has proposed 8 clinical quality indicators, focusing on effective care, patients’ experience, and patient safety (Table) to replace the 4-hour waiting time operational standard.12 Although the 4-hour target highlighted the need for efficiency in the emergency department, it was not an answer in itself, and these new indicators have evolved from this original concept. Time is still
Conclusion
The 4-hour wait operational standard to reduce waiting times and improve throughput through the emergency department was introduced in the United Kingdom in 2001 but has recently been replaced with 8 clinical quality indicators. Although the drive to reduce the waiting times in the emergency department by meeting the 4-hour target certainly had some benefits, the compromises sometimes required to achieve this have raised concerns. The new initiative takes into account waiting time but also
Alison Day, International Member of ENA, is Senior Lecturer in Emergency Nursing, Faculty of Health & Life Sciences, Coventry University, Coventry, England.
References (12)
- et al.
US emergency department performance on wait time and length of visit
J Emerg Nurs
(2010) The NHS Plan: A Plan for Investment, a Plan for Reform
(2000)Clinical Exceptions to the Four Hour Emergency Care Target
(2003)- et al.
The impact of the 4 h target on patient care and outcomes in the emergency department: an analysis of hospital incidence data
Emerg Med J
(2010) BMA claims that patients in A&E are being put at risk
Br J Nurs
(2005)- et al.
The “4-hour target”: emergency nurses’ views
Emerg Med J
(2007)
Cited by (4)
Modelling Granular Process Flow Information to Reduce Bottlenecks in the Emergency Department
2022, Healthcare (Switzerland)Patient waiting time in hospital emergency departments of Iran: A systematic review and meta-analysis
2017, Medical Journal of the Islamic Republic of IranPatient waiting time in hospital emergency departments of Iran: A systematic review and meta-analysis
2017, Medical Journal of the Islamic Republic of Iran
Alison Day, International Member of ENA, is Senior Lecturer in Emergency Nursing, Faculty of Health & Life Sciences, Coventry University, Coventry, England.
Carol Oldroyd, International Member of ENA, is Senior Lecturer in Cardiac Nursing, Faculty of Health & Life Sciences, Coventry University, Coventry, England.
Earn Up to 9 CE Hours. See page 409.
- ☆
Section Editors: Pat Clutter, RN, MEd, CEN, FAEN, and Carole Rush, RN, MEd, CEN, FAEN
- ★
Submissions to this column are encouraged may be sent to Pat Clutter, RN, MEd, CEN, FAEN[email protected]orCarole Rush, RN, MEd, CEN, FAEN[email protected]