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Patient journey: Longer hospital stay for A&E patients admitted in the fourth hour of attendance

New figures show patients admitted from A&E in the fourth hour(2) of attendance had longer hospital stays compared to those admitted within the first three hours (under the care of one consultant following admission)(4).

04 December 2014

*HSCIC must be quoted as the source of these figures

*Regional figures are available

Today's Health and Social Care Information Centre (HSCIC) report shows in the 12 months to August 2014 one in six admissions from A&E in the fourth hour stayed for 2-3 days (17 per cent or 228,800) and one in 16 stayed for 4-5 days (6 per cent or 82,100).3,4

For those admitted from A&E in the first hour, one in seven stayed for 2-3 days (14 per cent or 21,200) and one in 23 stayed for 4-5 days (4 per cent or 6,440)4.

Half of patients admitted in the first hour were discharged the same day (51 per cent or 74,500) compared to only one in three admitted in the fourth hour (36 per cent or 481,500)4.

Today's Provisional Monthly Hospital Episode Statistics (HES) for Admitted Patient Care, Outpatients and Accident and Emergency Data report is presented alongside the monthly provisional Hospital Episode Statistics publication released today and provides new analysis into a patient's journey after arriving at A&E.

The report also shows that for all hospital admissions from A&E in September 2013 to August 20143,5:

  • There were 18.8 million A&E attendances recorded in HES and more than one fifth resulted in a hospital admission (23 per cent or 4.3 million); this is similar to the same period last year3.
  • Over half of admissions from an unplanned6 A&E attendance occurred in the fourth hour (51 per cent or 1.9 million) of which 44 per cent (850,700) were admitted in the final ten minutes. A further one in five attendances were admitted after the four hour period (21 per cent or 791,300).
  • For those admissions where a cause code was recorded falls, unexpected complications from surgery and intentional self-poisoning were the main reasons for a hospital admission via A&E (38 per cent, 6 per cent and 9 per cent respectively).
  • One in five patients (21 per cent or 590,100) were admitted from A&E at least twice within the year and 41,900 (1 per cent) were admitted five or more times.
  • Men and women aged 80 to 84 years (4 per cent and 5 per cent respectively) accounted for the highest number of admissions.
  • Rate of admissions was highest in Bromley, Hounslow and Chiltern CCGs (418, 379 and 362 admissions per 1,000 A&E attendances respectively).

HSCIC Chair Kingsley Manning said: "Tracking a patient journey from A&E can be a powerful tool for secondary services and today's report provides new analysis of this.

The relationship between length of hospital stay and the point at which a patient is admitted from A&E provides valuable insight for all involved in secondary care."

You can find the full report at  


Notes to editors

1. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). It is England's trusted data source, delivering high quality information and IT systems to drive better patient services, care and outcomes. Its work includes publishing more than 220 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.

2. The national ambition in A&E departments is for patients to be discharged within four hours. The 'fourth hour' refers to patients who waited between three and four hours to be discharged.

3. Figures under 10,000 are rounded to the nearest 10 and figures over 10,000 are rounded to the nearest 100. Figures over one million are rounded to the nearest 100,000. Percentages are rounded to the nearest whole percentage.

4. An episode is a period of care under the care of one consultant. A spell is a period of care in hospital from admission to discharge and may be made up of one or more episodes of care. As this report focusses on emergency admissions via A&E information about the total length of stay in hospital is only available for those emergency admission episodes where the patient remains under the care of one consultant and result in the patient being discharged. Where the patient goes on to further episodes of care under a different consultant, these episodes have been excluded from the calculation of length of stay.

5. There were 4.3 million A&E attendances that led to a hospital admission and the Admitted Patient Care dataset provides information for 3.8 million of these which can be linked to give insight into patient journey from A&E through to hospital admission. The bullet points in this release refer to 3.8 million attendances from A&E.

6. Unplanned attendances are all attendances minus planned attendances. Planned attendances account for instances where follow up care is required and provided by an A&E department.

7. For media enquires or interview requests please contact or telephone 0300 30 33 888. Please note the change to our media line number.

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