New emergency department target cannot erode patient care and safety

Emergency nurse input is vital if one-hour treatment target is to succeed, says Tricia Scott

Emergency nurse input and addressing the current workload crisis are vital if new one-hour emergency department target for the most critically ill is to succeed, says Tricia Scott

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In 2018, 21 million patients received treatment in less than four hours in emergency departments (EDs) in England.

We know this because NHS England collates ED data using a range of metrics covering all types of attendances, including minor injury units, walk-in centres, and numbers discharged, admitted or transferred within four hours of arrival.

Additional data identifies those patients who waited in the ED for four hours or more after a decision had been made to admit them to hospital.

Patient surges

ED performance indicators have been available since 2003-04 and we know that patient attendances have significantly increased since that date.

From time to time adjustments to the percentage were made to arrive at the current figure of 95%, to cope with patient surges and staff workload.

However, emergency professionals are aware that ED patient figures are much more than simple statistics.

Complex conditions

This is because patients frequently present with highly complex predisposing conditions and multiple pathologies that make their care and treatment complex.

EDs have been experiencing the worst accumulative breach in four-hour performance over the past three years.

Patients most likely to be involved in breaches tend to be older, present at night, on a Monday, receive multiple types of investigation in the ED and are not self-referred (Bobrovitz et al 2017).

Experience and insight

Now, 15 years after the four-hour target was introduced, NHS England is piloting new one-hour treatment targets for the most critically ill at 14 sites across England. This includes people presenting with heart attack, stroke, sepsis and those in mental health crisis.

It is imperative that emergency nurses be consulted in this process to ensure that our experience and insight is heard regarding changes and that lessons learned from the trials are taken on board – whatever the outcome.

Further, the current workload crisis requires immediate attention if we are to achieve these targets.

Any changes to the four-hour standard must guarantee no less a level of quality patient care and safety than already exists, and must preferably enhance it.


Bobrovitz N, Lasserson D and Briggs A (2017) Who breaches the four-hour emergency department wait time target? A retrospective analysis of 374,000 emergency department attendances between 2008 and 2013 at a type 1 emergency department in England. 

Find out more

NHS England (2019) NHS to test new rapid care measures for patients with the most urgent mental and physical health needs

Tricia Scott is an independent nurse consultant and consultant editor of Emergency Nurse



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