Do Mandates Reduce Emergency Department Overcrowding?

Some valuable lessons are learned from the National Health Service's 4-hour length-of-stay imperative.

In response to emergency department (ED) overcrowding and long wait times, England's National Health Service (NHS) in 2005 mandated a maximum length of stay (LOS) of 4 hours for nearly all ED patients. Achieving the mandate resulted in financial remuneration, while failure led to undesired attention from the ministry of health. In 2008, these authors interviewed 27 leaders at nine NHS hospitals and identified common themes related to implementation of the mandate.

The percentage of ED patients with LOS <4 hours ranged from 76% to 95% before implementation of the 4-hour mandate to 86% to 99% after the mandate. At the time of the interviews, three hospitals had always performed well and continued to meet the target, three hospitals struggled f…

Reviewing Author

Richard D. Zane, MD, FAAEM

Disclosures

Nothing to disclose

Richard D. Zane, MD, FAAEM

Disclosures

Nothing to disclose