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Abstract
Objective To quantify the effect of intrahospital patient flow on emergency department (ED) performance targets and indicate if the expectations set by the National Health Service (NHS) England 5-year forward review are realistic in returning emergency services to previous performance levels.
Design Linear regression analysis of routinely reported trust activity and performance data using a series of cross-sectional studies.
Setting NHS trusts in England submitting routine nationally reported measures to NHS England.
Participants 142 acute non-specialist trusts operating in England between 2012 and 2016.
Main outcome measures The primary outcome measures were proportion of 4-hour waiting time breaches and cancelled elective operations.
Methods Univariate and multivariate linear regression models were used to show relationships between the outcome measures and various measures of trust activity including empty day beds, empty night beds, day bed to night bed ratio, ED conversion ratio and delayed transfers of care.
Results Univariate regression results using the outcome of 4-hour breaches showed clear relationships with empty night beds and ED conversion ratio between 2012 and 2016. The day bed to night bed ratio showed an increasing ability to explain variation in performance between 2015 and 2016. Delayed transfers of care showed little evidence of an association. Multivariate model results indicated that the ability of patient flow variables to explain 4-hour target performance had reduced between 2012 and 2016 (19% to 12%), and had increased in explaining cancelled elective operations (7% to 17%).
Conclusions The flow of patients through trusts is shown to influence ED performance; however, performance has become less explainable by intratrust patient flow between 2012 and 2016. Some commonly stated explanatory factors such as delayed transfers of care showed limited evidence of being related. The results indicate some of the measures proposed by NHS England to reduce pressure on EDs may not have the desired impact on returning services to previous performance levels.
- 4 hour target
- performance target
- five year forward view
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Footnotes
Contributors RG-L created the initial research question. BK contributed to the initial design of the work and was responsible for the protocol/ethics, data acquisition and collation, coding, analysis and interpretation of results. DC was responsible for the statistical methodology and interpretation of results. TM was involved throughout the study with guidance in the design, methodology and interpretation of results. All authors were involved in the development and review of the manuscript.
Funding This article presents independent research funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex.
Disclaimer The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service, the NIHR or the Department of Health and Social Care.
Competing interests None declared.
Patient consent Not required.
Ethics approval This study was reviewed by University of Southampton ERGO ethics committee (reference 25957).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data utilised in this study can be accessed via the Dryad data repository at doi:10.5061/dryad.n71684c. Further data associated with this study is available at doi:10.5258/SOTON/D0218.