The Impact of Prolonged Emergency Department Waiting Time on Elective Surgical Activities: A Cross-Sectional Observational Study in National Health Service (NHS) Scotland.

Abstract

Introduction: The NHS is now facing serious challenges from acute care pressure, reflecting on the emergency department (ED) national waiting time target compliance. Concerns about cancelling elective operations to cope with emergency services have also arisen. However, there is a lack of existing evidence to prove a direct relationship between ED episodes and planned hospital services. Thus, the objective of this study is to investigate the impact of high ED attendances on elective surgical activities.

Methods: Retrospective cross-sectional observational study which includes the five largest health boards in NHS Scotland. All patients who presented to the ED in 2021 are included. Univariate and multivariate regression analysis were used to show relationship between ED attendances and elective surgical services including in- and out-patient waiting lists and clinic activities. Explanatory variables include total ED attendances and attendances that exceeded the national waiting time target.

Results: The five health boards recoded a higher patient visit to ED on second and third quarter. Non-compliances to 4 hours waiting time ranges between 6% and 20%. Both Univariate and multivariate regression analysis showed a positive correlation between long ED waiting time (> 8 and 12 hours) and increased patient waiting time for elective surgical service as well as delay in clinic review.

Discussion: Prolonged ED waiting times were consistently associated with delay in in- and out-patient elective service. To ensure timely and adequate treatment of patients, policymakers should invest in resources to improve the efficiency of both emergency and elective services and introduce management plans that balance the needs of both services.