TY - JOUR T1 - Abstracts JF - Journal of Epidemiology and Community Health JO - J Epidemiol Community Health SP - A1 LP - A36 VL - 62 IS - Suppl 1 A2 - , Y1 - 2008/10/01 UR - http://jech.bmj.com/content/62/Suppl_1/A1.abstract N2 - Parallel session AHealth services research001. THE IMPACT OF GOVERNMENT-SET TIME TARGETS ON PATIENT CARE AND OUTCOMES: A RETROSPECTIVE ANALYSIS OF ROUTINE DATA1J Freeman, 1,2S Mason, 2S Croft, 2C. Yap, 2S Cross. 1School of Health and Related Research, University of Sheffield, Sheffield, UK, 2Emergency Department, Sheffield Teaching Hospitals Trust, Sheffield, UKBackground: Recent government initiatives within the NHS have seen care becoming increasingly target driven. In 2000, the NHS announced a target of 4 h between arrival and discharge or admission for patients in the emergency department (ED); a target of 90% seen within 4 h was set for March 2004 and 98% for January 2005. However, the impact of targets (positive and negative), and particularly those that are based on a time-frame, have not been extensively studied and concerns have been raised about the unintended consequences for patients that might arise from stringent time-related targets. These include the possibility of clinicians making rushed decisions without complete information, resulting in missed diagnoses, unnecessary hospitalisations or revisits to the ED for the same problem, and most recently, of patients queuing in ambulances before admission to the ED.Objective: To evaluate the effect of the 4-h target on patient care and outcomes.Design: Retrospective analysis of hospital records data.Setting: Large urban ED in the north of England.Participants: Anonymised patient-level data from 560 000 new patient episodes between April 2000 and February 2006.Main Outcome Measures: Time spent in the ED, mortality, admission rate, one-day hospitalisations, repeat visits to the ED and investigations performed for periods before, during and after the 4-h target.Methods: Interrupted time-series analysis was used to examine changes in patient outcomes during the study period.Results: Median time to see a clinician fell from before the target was introduced to after it was established (53 to 37 minutes, p<0.001). Median total ED time also fell (119 to 93 minutess, p<0.001). Overall, the … ER -