Performing or not performing: what's in a target?

Abstract

This paper analyses how providers have coped with the 4-hour target over the past 7 years. To do this, we used publicly available data from NHS Digital to track how long patients remain in accident and emergency (A&E) departments and their 'atten-dance disposal method'. Using this tool, we compared two A&E departments with similar arrival patterns and age profi les and that perform equally well against the target in a specifi c year. However, these hospitals exhibit very different underlying behaviour. Over 7 years, both exhibit a general increase in length of stay, increasing number of patients being admitted in the 20 minutes preceding the 4-hour target, and rising numbers of patients that breach the target. Despite the two hospitals having similar input profi les there is a 12 percentage point difference in the number of patients who leave the A&E department in the last 20 minutes. This operational information is not visible simply by monitoring the single existing metric. We conclude that the 4-hour target in isolation is an inadequate measure and we refl ect on the difference between selecting measures for policy-level review, and for operational management. A link to download the graphs for each A&E in England is available.