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PB13 The Four-Hour Rule: time for a new approach?
  1. A Mackenzie1,
  2. R D W O'Donnell2
  1. 1School of Medicine, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
  2. 2Western Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK


Objectives and Background The “Four-Hour Rule” (FHR) was introduced in Scotland in 2007 and remains in effect. In England and Wales this has been replaced by a range of quality indicators that came into effect on 1st April 2011. We assessed the compliance of a central Glasgow Emergency Department (ED) with Scottish standards for the FHR, how well said ED complies with new time-based quality measures and investigated the correlation between the FHR and other time-based quality indicators. Patient encounters from a central Glasgow ED spread over two consecutive days were retrospectively captured using the ED Information System.

Methods 487 patient encounters were captured. Following exclusion criteria n=472. Mean length of time spent in the ED=2.20 h. In 2.75% (13) patient encounters total time spent in the ED was >4 h. For 3.25% (4) of 123 patients arriving by ambulance time to initial assessment was longer than the published 20 min target. Median time to treatment=51.0 min (target: median=60.0 min).

Results and Conclusions Analysis of this dataset suggests that the study ED may not be meeting the Scottish government target of “98% of patients seen then admitted, transferred or discharged within 4h” The study ED does, however, achieve the College of Emergency Medicine target of 95%. When the new time-based quality measures are applied to the same dataset the study ED is shown to be achieving the median target time to treatment of 60 min but does not achieve the target of 100% patient arriving by ambulance receiving an initial assessment within 20 min of arrival. There is no meaningful correlation between time to initial assessment and total time spent in ED (r=0.033, p=0.71) but a reasonable correlation between time to treatment and total time spent in ED (r=0.409, p=0.000001).

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