Why are there long waits at English emergency departments?

James Gaughan, Panagiotis Kasteridis, Anne Mason and Andrew Street

LSE Research Online Documents on Economics from London School of Economics and Political Science, LSE Library

Abstract: A core performance target for the English National Health Service (NHS) concerns waiting times at Emergency Departments (EDs), with the aim of minimising long waits. We investigate the drivers of long waits. We analyse weekly data for all major EDs in England from April 2011 to March 2016. A Poisson model with ED fixed effects is used to explore the impact on long (> 4 h) waits of variations in demand (population need and patient case-mix) and supply (emergency physicians, introduction of a Minor Injury Unit (MIU), inpatient bed occupancy, delayed discharges and long-term care). We assess overall ED waits and waits on a trolley (gurney) before admission. We also investigate variation in performance among EDs. The rate of long overall waits is higher in EDs serving older patients (4.2%), where a higher proportion of attendees leave without being treated (15.1%), in EDs with a higher death rate (3.3%) and in those located in hospitals with greater bed occupancy (1.5%). These factors are also significantly associated with higher rates of long trolley waits. The introduction of a co-located MIU is significantly and positively associated with long overall waits, but not with trolley waits. There is substantial variation in waits among EDs that cannot be explained by observed demand and supply characteristics. The drivers of long waits are only partially understood but addressing them is likely to require a multi-faceted approach. EDs with high rates of unexplained long waits would repay further investigation to ascertain how they might improve.

Keywords: Accident and emergency (A&E); Emergency department (ED); length of stay; National Health Service (NHS); waiting time (search for similar items in EconPapers)
JEL-codes: I10 (search for similar items in EconPapers)
Pages: 10 pages
Date: 2020-03-01
New Economics Papers: this item is included in nep-eur and nep-hea
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

Published in European Journal of Health Economics, 1, March, 2020, 21(2), pp. 209 - 218. ISSN: 1618-7598

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Journal Article: Why are there long waits at English emergency departments? (2020)
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Persistent link: https://EconPapers.repec.org/RePEc:ehl:lserod:102571

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