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|Title:||Performing or not performing: what’s in a target?|
|Citation:||Future Hospital Journal|
|Abstract:||This paper analyses how providers have coped with the 4-hour target over the past 7 years. To do this, we use publically available data from NHS digital to track how long patients remain in A&E departments and their “attendance disposal method.” Using this tool, we compared two A&E departments with similar arrival patterns and age profiles and that perform equally well against the target in a specific 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 profiles 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 reflect 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.|
|Appears in Collections:||Dept of Clinical Sciences Embargoed Research Papers|
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|Metric Paper (Revisions v3).pdf||Embargoed until 12 months after publication||451.57 kB||Adobe PDF||View/Open Request a copy|
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