Effectiveness of measures to reduce emergency department waiting times: a natural experiment.

OBJECTIVES: To determine what measures were introduced by emergency departments in response to the national monitoring week in March 2003, and which, if any, of these were most effective in reducing waiting times.
METHODS: A postal survey of all emergency departments in England was undertaken to gather data on measures taken. Department waiting times before, during, and after monitoring week were determined from data held by the Department of Health and linked to the survey data for analysis.
RESULTS: A total of 111/198 responses (56%) were received. Departments had taken a wide range of measures to improve waiting times. The commonest were additional senior doctor hours (39%), creation of a "four hour monitor" role (37%), improved access to emergency beds (36%), additional non-clinical staff hours (33%), additional junior doctor hours (32%), additional nursing hours (29%), and triage by senior staff (28%). In 35 departments (32%) no changes were made at all to usual practice. The biggest influence on improved performance during monitoring week was the number of measures that a department took, rather than any specific measure, although there was weak evidence that additional junior medical and non-clinical staff time may have contributed more than other measures.
CONCLUSIONS: Improved waiting time performance may depend, at least in the short term, more on the amount of effort expended than on introducing a single effective change. In addition, those measures most likely to be helpful are likely also to require additional resources.