Does the Number of Emergency Department Attendances to a Hospital Influence Health Care Regulator Ratings?

The pressure on healthcare systems means that maintaining quality of care can be challenging. Hospitals which receive high volumes of patients through their Accident and Emergency Departments are susceptible to the impact of exit block which has been shown to impact on the standard of care provided. This study examined the hypothesis of whether trusts with higher rates of emergency attendances, received lower quality ratings from their health regulator.

The number of A and E attendances per trust was compared with the most recent care quality commission (CQC) ratings for each trust. In relation to the Overall rating there was a clustering of Outstanding ratings at levels of attendance less than 200,000. However, statistical analysis showed an insignificant trend. Similar patterns were seen for the sub-domains “safe” and “well-led”. While there was no direct relationship between A&E attendances and CQC ratings there appears to be a threshold of 200000 attendances, above which, a rating of outstanding becomes difficult to achieve.

We highlight the issue of exit block and crowding which may result in challenges for the trust as a whole and not just for Emergency Department. It may also be useful for health regulators to be mindful of underlying health system issues in their evaluation of hospitals.

Keywords: Emergency Care, Regulation, Health Services, Quality.