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The impact of changing the 4 h emergency access standard on patient waiting times in emergency departments in England
  1. Thomas Woodcock,
  2. Alan J Poots,
  3. Derek Bell
  1. Imperial College London and NIHR CLAHRC for Northwest London, London, UK
  1. Correspondence to Professor Derek Bell, CLAHRC NWL, Floor 4 Lift Bank D, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK; d.bell{at}


Objective To determine whether the process of emergency care waiting in England has changed following the modification of the operational standard for the 4 h waiting time target from 98% to 95% in June 2010.

Design Retrospective analysis of publicly available ‘total time spent in accident and emergency’ data from Department of Health.

Setting and participants Patients attending emergency departments (EDs) in England between October 2002 and September 2011. In 2005, the government set an operational standard that 98% of patients should wait <4 h in ED. In June 2010, the government announced that the operating standard would change to 95% immediately.

Outcome measures Percentage of patients waiting <4 h (weekly and quarterly), and total number of patients waiting >4 h.

Results The average percentage of patients waiting <4 h fell from 98% to 95% almost immediately following the operational standard change. Consequently, between October 2010 and September 2011, approximately 383 000 additional patients in England EDs waited in excess of 4 h than had the 98% standard been attained. The emergency care system appears to have been stabilised at this new level.

Conclusions The policy change for waiting times in EDs in England has resulted in the process of emergency care in England adjusting to the new operational standard of 95% of patients waiting <4 h. As a result, more patients are waiting >4 h to receive the care they need; consequently, outcomes are likely to suffer.

  • Emergency department
  • waiting times
  • statistical process control
  • statistics

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  • Funding Staff in part funded by National Institute for Health Research Collaboration for Leadership In Applied Health Research and Care for Northwest London.

  • Disclaimer This article presents independent research commissioned by the National Institute for Health Research (NIHR) under the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) programme for North West London. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement All data used are available from the Department of Health (UK) website.