Editorial

74

Key points ■ NHS England plans to abolish the 4-hour emergency department target ■ The target has been criticised as lacking a clinical rationale. ■ Research has shown that long waits for admission are associated with increasing patient mortality. ■ The target is appropriate and clinically relevant: it should not be abolished, and hospitals and NHS England should make renewed efforts to meet it.

such as diverting patients away from emergency departments. This does not seem to have a notable effect on attendance and, even if it did, would have little impact on performance.

NHS England has proposed abolishing the 4-hour metric and replacing it with a range of other – much less useful – metrics. Given the relationship between long waits and mortality, NHS England should abandon its attempts to obfuscate the key metrics for emergency departments and refocus its efforts to understand the causes of long waits and eliminate them, as should hospital managers.

Author details 1Black Box Data Science, Bedford, UK References Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA. Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ. 2011;342:d2983. https://doi.org/10.1136/bmj.d2983 Jones S, Moulton C, Swift S et al. Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emerg Med J. 2022;39(3):168–173. https://doi.org/10.1136/ emermed-2021-211572 Kituno N. Four-hour A&E standard is the ‘wrong target’, claims Javid. 2022. https://www.hsj.co.uk/

acute-care/four-hour-aande-standard-is-the-wrong-target-claims-javid/7031770.article (accessed 14 February 2022) Monitor. A&E delays: why did patients wait longer last winter? 2016. https://assets.publishing.service.gov.

uk/government/uploads/system/uploads/attachment_data/file/458764/AE_delay_main_report_final.pdf (accessed 14 February 2022) NHS England. Transformation of urgent and emergency care: models of care and measurement. 2020.

https://www.england.nhs.uk/publication/transformation-of-urgent-and-emergency-care-models-of-careand-measurement/ (accessed 14 February 2022) NHS England. A&E attendances and emergency admissions 2021–22. 2021. https://www.england.nhs.

uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/ae-attendances-and-emergencyadmissions-2021-22/ (accessed 14 February 2022) NHS. Wait for a bed – bed management further guidance. 2004. https://webarchive.nationalarchives.

gov.uk/ukgwa/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4083664?IdcService=GET_FILE&dID=12621&Rendition=Web (accessed 14 February 2022) Royal College of Emergency Medicine. Winter flow project 2021/22. 2021. https://rcem.ac.uk/winter-

flow-project/ (accessed 14 February 2022) Topping A, Campbell D. Waiting targets for accident and emergency to be scrapped. 2010. https://

www.theguardian.com/politics/2010/jun/10/accident-and-emergency-waiting-time-nhs (accessed 14 February 2022)

L t d l t h c a r e

H e a

M A

2 0 2 2

©

British Journal of Hospital Medicine  | March–April 2022  |  https://doi.org/10.12968/hmed.2022.0090