Four hour emergency department rule has mixed results

A rule implemented in England, that no patient should wait more than 4 hours from arrival at the Emergency Room to admission, transfer or discharge has had mixed results, according to the Annals of Emergency Medicine.  The rule went into effect in 2004. 

Key findings from the study:

  • The percentage of ER patients seen within 4 hours increased from 83.9 percent in 2003 to 96.3 percent in 2006.
  • Time to see a physician improved by 1 minute for all patients after the rule was put in place.
  • Although average total time in the emergency department fell initially from 119 minutes in 2003 to 107 minutes in 2004, the number rose back to 114 minutes in 2006.
  • Elderly patients spent between 40 – 47 minutes less in the emergency department after the rule went into effect, however the number of elderly patients seen within the last 20 minutes of the 4-hour window increased each year after the rule went into effect.

The study concludes that although the 4 hour rule has reduced the overall amount of time that patients spend in the ER, the effect has been less effective for elderly patients.

(Sources: Annals of Emergency Medicine,, November 2011; The Advisory Board Daily Briefing, November 11, 2011)