Hospital performance measured against the 4-hour target

Background

Activity in Accident & Emergency (A&E) departments has historically been obtained from the ISD(S)1 data collection scheme which provides very basic information about the number of new and return patients seen in A&E on a monthly basis.

More detail about this activity has been obtained from the results of yearly national censuses, which covered a 3 or 7-day period in April. This included an estimate of a hospital's performance against the 4-hour target. This census covered only a set of core hospitals but in 2006 was extended to cover all A&E departments including minor-injury units. However, a yearly census cannot be used to monitor and manage such a target.

Monthly monitoring data for the core sites has been provided through the Unscheduled Care Collaborative Programme.  These data, under development since September 2005, were initially intended to inform service improvement and redesign. Work has been undertaken to improve the quality, robustness, timeliness and completeness of the data and NHS Boards have agreed that the data can be used to estimate performance against the target.

A substantial amount of data is collected under the Collaborative Programme and much is used at the local level to inform service improvement and breach avoidance; it would not therefore be appropriate to release this in the public domain.  Analysis allows drill down to increasing levels of detail to understand the effect of the high impact changes and site-specific variation.

Emphasis is now being placed on the implementation of a sustainable system and an embedded process at ISD for analysis and reporting.  Longer term, this should allow these statistics to be brought within the scope of National Statistics.

Data Coverage and Quality

The nationally procured EDIS information system has been installed by the majority of NHSBoards and is used to collect the data reported here.  Under exceptional circumstances a small number of Boards have had their existing systems compliance tested to allow amalgamation and analysis of information nationally.  All systems use items drawn from both the National Clinical Dataset Development Programme A&E dataset and from the generic datasets.

Monthly performance data under development for core and non-core sites are presented.  Non-core sites include small hospitals with manual systems and health centres in rural areas that carry out A&E type activity.  In NHS Highland for example, approximately 60% of total attendances take place in non-core sites.  Work is ongoing to ensure that data from all non-core sites can be collected from their manual systems.

The target for Scotland differs from the English standard in its inclusion of trolleyed areas of assessment units. Making comparisons across the home countries would therefore not be meaningful.

ISD are working closely with colleagues to improve the validation and accuracy of the data and to ensure that the appropriate data standards are understood and applied by all sites.

Performance

A fully integrated approach to performance improvement and performance management has been developed between the Unscheduled Care Collaborative Programme and the Emergency Access Delivery Team. This includes a joint approach to performance improvement and risk management.  Agreed delivery trajectories are in place for each NHS Board and each core site to enable continuous improvement and ensure target compliance through careful planning.

The tables describe performance against target for all A&E sites as well as detailed information each core and non-core site's performance both in terms of numbers of patients and in the proportion for which the hospital achieved the target.  The figures cover the period from April 2006 to December 2007 for core sites and July to December 2007 for non-core sites.  They will be updated quarterly.

• Accident and Emergency: Performance against 4-hour target for all sites (aggregate)
• Accident and Emergency: Performance against 4-hour target for all core and non core sites
• Accident and Emergency: Performance against 4-hour target for all core sites

Historical A&E Survey Results

The Survey Results section contains tables showing the results of the 2006 survey and selected trend information and a link to an archive section with historically published data.