A group of senior doctors say they cannot find any evidence that the four hour Accident and Emergency target set for hospitals benefits patients’ clinical care. In the BMJ today they say the system has encouraged target-led rather than needs-led care.

The nationwide four hour standard for processing patients in emergency departments was introduced in 2004 at an initial 90 per cent level, and was increased to 98 per cent a year later. Last week, the target was relaxed to 95 per cent by the new coalition Government.

In a letter to the BMJ, Suzanne Mason, the Director of Health Services Research at the University of Sheffield and colleagues say that in 2005 they showed that patients admitted to hospitals from emergency departments were affected by a “spike” in activity during the last 20 minutes of the four hour period. Now, in an attempt to find out whether this spike was still occurring nationally, they have analysed 12.2 million new patient episodes at English emergency departments during 2008-2009. This shows the phenomenon is still present and larger than before.

“Although many in the specialty of emergency medicine support the benefits that the four hour target has brought, these results suggest that they are not being experienced by all patients, and that processes throughout the hospital and wider healthcare system may not have improved to accommodate it,” they say. In their letter they say evidence-based indicators of quality in emergency medicine need development.