Which patients spend more than 4 hours in the Accident and Emergency department?

Objectives 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 an over 8 hours in A&E. The groups were compared in terms 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 AE; 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.