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Exploring emergency department 4-hour target performance and cancelled elective operations: a regression analysis of routinely collected and openly reported NHS trust data

Exploring emergency department 4-hour target performance and cancelled elective operations: a regression analysis of routinely collected and openly reported NHS trust data
Exploring emergency department 4-hour target performance and cancelled elective operations: a regression analysis of routinely collected and openly reported NHS trust data
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: nivariate 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.
2044-6055
Keogh, Bradley
b698d61e-30f2-483a-bd87-41368c08f708
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Guerrero-Luduena, Richard
db129ad5-e7f4-427c-b834-34fd22d67537
Monks, Thomas
fece343c-106d-461d-a1dd-71c1772627ca
Keogh, Bradley
b698d61e-30f2-483a-bd87-41368c08f708
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Guerrero-Luduena, Richard
db129ad5-e7f4-427c-b834-34fd22d67537
Monks, Thomas
fece343c-106d-461d-a1dd-71c1772627ca

Keogh, Bradley, Culliford, David, Guerrero-Luduena, Richard and Monks, Thomas (2018) Exploring emergency department 4-hour target performance and cancelled elective operations: a regression analysis of routinely collected and openly reported NHS trust data. BMJ Open, 8 (5), [e020296]. (doi:10.1136/bmjopen-2017-020296).

Record type: Article

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: nivariate 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.

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Accepted/In Press date: 10 April 2018
e-pub ahead of print date: 24 May 2018
Published date: 24 May 2018

Identifiers

Local EPrints ID: 421232
URI: http://eprints.soton.ac.uk/id/eprint/421232
ISSN: 2044-6055
PURE UUID: f090e1eb-7dbc-42f4-9760-68e533ea900d
ORCID for Bradley Keogh: ORCID iD orcid.org/0000-0003-2960-0918
ORCID for David Culliford: ORCID iD orcid.org/0000-0003-1663-0253
ORCID for Richard Guerrero-Luduena: ORCID iD orcid.org/0000-0002-1217-015X
ORCID for Thomas Monks: ORCID iD orcid.org/0000-0003-2631-4481

Catalogue record

Date deposited: 25 May 2018 16:30
Last modified: 02 Jun 2024 01:46

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Contributors

Author: Bradley Keogh ORCID iD
Author: David Culliford ORCID iD
Author: Thomas Monks ORCID iD

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