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Spill over effects of inpatient bed capacity on Accident and Emergency performance in England

Friebel, Rocco ORCID: 0000-0003-1256-9096 and Juarez, Rosa M. (2020) Spill over effects of inpatient bed capacity on Accident and Emergency performance in England. Health Policy, 124 (11). 1182 - 1191. ISSN 0168-8510

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Identification Number: 10.1016/j.healthpol.2020.07.008


The English National Health Service (NHS) has failed to meet the four-hour waiting time target to admit, transfer or discharge 95 per cent of patients attending Accident and Emergency Departments (A&E) since 2013. A growing number of patients requiring inpatient care are waiting on trolleys longer than four hours before admission to a hospital bed. This study examines the role of bed occupancy in the deterioration of A&E performance in the NHS. Longitudinal panel data methods are used to analyse hospital data (n = 72,129,886) for 143 Trusts from 1st June 2016 to 31st October 2019. The average bed occupancy rate across the study period was 93.2%. A 1% increase in bed occupancy was associated with a 9.5 percentage point decrease in the Trusts’ probabilitay of meeting the waiting target, and an approximately 6 patient increase in four hours to 12 -hs trolley waits per 1,000 admissions. These relationships became more pronounced with rising bed occupancy levels above a 90% threshold. Bed occupancy is associated with significant negative spill-over effects on A&E performance. We estimate a minimum investment in 3,861 additional inpatient beds across the NHS to improve A&E performance in England. Relevant lessons can be derived for health care systems that have observed similar trends in increasing bed occupancy and deteriorations in A&E performance, including Ireland, Canada and Israel.

Item Type: Article
Official URL:
Additional Information: © 2020 Elsevier B.V.
Divisions: Health Policy
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited: 27 Aug 2020 12:39
Last Modified: 20 Feb 2024 09:18

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