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Waiting times in Emergency Departments: inequalities and impact on health outcomes (ED-WAITS)

Crowding and long waits in Emergency Departments (EDs) – previously known as Accident and Emergency (A&E) – are problems for healthcare systems worldwide. In England, there were 25 million attendances in 2019/20 – 17% more than in 2010/11. 28% of patients now wait more than four hours in EDs. We know there is a strong link between deprivation and health. There are more ED attendances in deprived areas. Waiting times for planned operations are longer for patients from deprived areas but we don’t know if the same is true for waiting times for unplanned ED care. We also do not know whether people who wait longer in EDs have worse health outcomes. This study will provide vital information to ensure ED care is fair and timely. We will: (i) Examine whether there are inequalities in ED waits, by deprivation, age, gender, ethnicity and other factors (ii) Analyse the impact of waiting in EDs on patients' health (iii) Explore whether differences in the organisation of EDs lead to differences in how patients are prioritised and treated For i) and ii) we will use data already collected by the NHS. They will be prepared for us in a way that means we cannot identify the patients. We will cover the years 2018-22 and be careful to consider the effects of the COVID-19 pandemic. We will look first at all health conditions combined, comparing patients who have the same severity (how sick patients are). We will look in detail at conditions that occur most frequently among more deprived populations: heart failure, chronic obstructive pulmonary disease and asthma. For (iii), we will observe and talk to patients/relatives and staff in four English EDs, three of which will be in areas of high deprivation. We will track 20 patients in each ED from arrival/initial assessment until they are admitted into hospital or leave and shadow 15 staff members to watch what different members of staff and patients do. Across the sites we will interview up to 40 staff and 40 patients/relatives to understand their experiences. We will make detailed notes about how the EDs are organised and their different work practices and collect data about waiting times and numbers of people waiting. These data will be thematically analysed to explore differences in practices and processes. We spoke to a variety of people, including ED staff, policymakers and charities, who confirmed the importance of our research questions. Our research team and advisers include emergency health care professionals, senior strategic leaders in NHS England and members of two medical Royal Colleges.

Department project leads

COLLABORATORS:

  • Dr Alex Novak, Consultant in Emergency Medicine and Ambulatory Care, Oxford University Hospitals NHS Foundation Trust

  • Dr James Ray, Consultant in Emergency Medicine, Oxford University Hospitals NHS Foundation Trust

  • Lois Greenhalgh (PPI co-applicant)


Dates:

February 2023 – August 2025


FUNDER:

NIHR Health and Social Care Delivery Research (HSDR) Programme