A&E departments are experiencing a perfect storm of factors leading to an increase in waiting times

February 2017

Emergency Care

Country of origin: UK

As hospitals throughout the country increasingly fail to hit A&E targets, patients in England have been warned they could expect greater waits in emergency units.

Days after NHS England data revealed major emergency units had missed the target to treat, admit or discharge emergency patients within four hours for an unprecedented 52 weeks in a row, a wide-ranging new analysis from the Nuffield Trust and Health Foundation uncovers the reasons behind these breaches.

The report tracks a number of contributing factors leading to struggles in A&E. It shows that crowding (the number of people in a department at any one time) is closely linked to waiting times. Crowding has risen as the population has grown and aged, while the number of A&E units has been frozen or reduced under successive governments. There was an 8% increase in crowding between 2010/11 and 2012/13 despite only a 3% rise in attendances – a trend which is likely to continue.

The analysis shows that winter pressures were associated with higher rates of people waiting more than four hours, but by less than most people think. Challenging conventional wisdom, it highlights the strain hot weather puts on A&E departments - when average daily temperatures hit 20°C compared with 5°C, trips to A&E rise by nearly 20%. However, very cold weather does also cause longer waits, and raises the chances of patients needing to be admitted to hospital.

Tracking 41 million A&E attendances from 2010 to 2013, the report exposes an age gap where older people wait in A&E longer than children and younger adults. This is due in part to the complexity of conditions which older people suffer, which often require longer periods of care – but older adults have also seen the fastest increase in waits which breach the four hour target. People over 75 spent around three and a half hours in A&E on average, compared with two and a half hours for under-75s.

Patients who suffer from long-term conditions like arthritis also wait longer to be admitted or discharged, and those with more than one condition wait longest of all. However, aging and long term conditions only explained a small amount of the increase in breaches of the four hour target.

The analysis shows that people whose local GP practice had better patient feedback were less likely to attend emergency units. Practices which were rated as easy to reach by telephone also saw fewer patients go to A&E. However, GP satisfaction did not make a difference to breaches of the four hour target.

Underlying this wider picture, links were also found between long A&E waits and the availability of beds on hospital wards.

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