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Older patients are more likely to breach the 4-hour target in Scotland
  1. Jonathan Quinn1,
  2. Scott Buchanan2,
  3. Phyo Kyaw Myint1,3,
  4. Graham Ellis4,5
  1. 1 Ageing Clinical and Experimental Research Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  2. 2 NHS National Services Scotland, Information Services Division, Healthcare Improvement Scotland, Edinburgh, UK
  3. 3 Department of Medicine for the Elderly, NHS Grampian, Aberdeen, UK
  4. 4 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
  5. 5 NHS Lanarkshire, Bothwell, UK
  1. Correspondence to Professor Graham Ellis, Glasgow Caledonian University, Glasgow G4 0BA, UK; g.ellis{at}


Objective To determine if age is a factor in a patients’ likelihood of breaching the 4 hour time target to admission/discharge in emergency departments (EDs) within NHS Scotland.

Methods We used data from the Information Service Division Scotland to analyse all ED attendances in Scotland between January 2015 and September 2018 (n=5 596 642). We assessed the likelihood of time to admission/discharge being within 4 hours, 8 hours and 12 hours for all age categories (reference category 20 to 24 years). Univariable logistic regressions were carried out for sex, Scottish Index of Multiple Deprivation level and both major (potentially life threatening) and minor (not immediately life threatening) incidences.

Results The likelihood of breaching the 4-hour target increased linearly with age from 15 to 19 years upward. Patients ≥85 years were significantly (p<0.001) more likely to have breached than patients aged 20 to 24 years (OR 3.80, 95% CI: 3.73 to 3.86). When considering major incidents, patients aged ≥85 years were more likely to have breached than those aged 20 to 24 years (OR 2.05, 95% CI: 2.01 to 2.09, p<0.001). The same was true of minor incidents (OR 2.85, 95% CI: 2.73 to 2.98, p<0.001).

Conclusions Older age is associated with a higher probability of breaching waiting time targets in a linear fashion within NHS Scotland, which is consistent with previous single hospital or regional studies. This association may be due to the higher proportion of elderly patients being admitted or a more systemic issue, but regardless, the elderly are being put more at risk.

  • emergency care systems
  • emergency departments
  • emergency department management

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  • Contributors GE and PM conceived the study. SB provided the data for the study. JQ drafted the initial version along with statistical analysis. All authors then subsequently contributed numerous revisions to the final manuscript. GE is responsible for the overall content of the manuscript.

  • Funding This work is carried out as part of Scottish Care of Older People (SCoOP) National Audit Programme, an initiative set up in late 2016 by three key stakeholder organisations, Healthcare Improvement Scotland, the British Geriatrics Society Scotland Council and the University of Aberdeen.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available in a public, open access repository. Data available from Information Services Division Scotland.