This statistical brief presents information on the time waited in emergency care departments (EDs) in Northern Ireland, including information on a series of clinical quality indicators detailing the key milestones of a patients time in an ED. Further information on data included in this release is available at the link below:

https://www.health-ni.gov.uk/sites/default/files/publications/health/hs-niwts-ecwt-guidance.pdf

Summary of Key Points

The flowchart below presents a summary of the key milestones in NI EDs during the latest month.

How many Attend ED

Attendances

During December 2019, 64,872 patients attended EDs in Northern Ireland, 1,764 (2.6%) less than December 2018 (66,636). Information is also detailed in the heatmap below on the number of attendances at EDs each month from April 2008.

Heatmap of Attendances at all EDs

During this period, the Ulster (7,888) reported the highest number of attendances at Type 1 EDs, whilst SWA reported the lowest (3,179).

Attendances at Type 1 EDs

Attendances at EDs

The interactive map below presents the number of ED attendances per 1,000-population for each Super Output Area (SOA) in Northern Ireland. Super Output Areas were developed by the Northern Ireland Statistics & Research Agency (NISRA) to improve the reporting of small area statistics.

During December 2019, the highest number of attendances at EDs per 1,000-population was in the Whiterock 3 super output area (70.1), whilst the lowest rate was in Stranmillis 2 super output area (13). Further information is detailed in the interactive map below, where the super output area, number of attendances per 1,000-population and number of referrals to EDs by a GP per 1,000-population are displayed when you hover over each area. It is also possible to zoom in and out of the map.

If you need to reset the view of the map, select to reload map.

The interactive map below presents the standardised ED attendance rate (SAR) per 1,000 population for SOA in Northern Ireland by deprivation level, and is presented in 3 SAR categories:

Green indicates areas where the standardised ED attendance rate is LOWER than NI as a whole
Yellow indicates areas where the standardised ED attendance rate is SIMILAR to NI as a whole
Orange / red indicates areas where the standardised ED attendance rate is HIGHER than NI as a whole

Additional information is detailed for each SOA when you hover over the map, including the deprivation quintile for each Super Output Area and wthether or not it was in Quintile 1 “the Most Deprived 20%” or Quintile 5 “the Least Deprived 20%”. SOAs NOT in the Most or Least Deprived Quintiles are indicated as “-”. Due to small numbers the data presented in the standardised ED attendance map for SOAs in NI below refers to the 2018/19 financial year.

It is also possible to zoom in and out of the map. If you need to reset the view of the map, select to reload map.

The diagram below presents information on attendances at EDs for December 2019 compared with December 2018, for each HSC Trust and Department. To view the number of attendances, hover over each segment. The size of each segment is based on the number of their ED attendances.

If you need to reset the diagram, right-click anywhere on the diagram and select reload.

Attendances for Latest Month & Same Month Last Year, by Department

Admissions

The chart below presents information on the percentage of ED attendances which resulted in an emergency admission to hospital, during each month since April 2014.

During December 2019, 19.9% of the 64,872 attendances at EDs were admitted to hospital. Since April 2014, the percentage of ED attendances admitted to hospital ranged from 17.1% in June 2018 to 23.7% in January 2015.

Across Type 1 EDs, the Craigavon (28.0%) reported the highest percentage of attendances at ED being admitted to hospital.

Percentage of ED Attendances Admitted to Hospital from ED

Week Day

The number of attendances at EDs is presented below for each day of the week and hour during December 2019. Overall, Monday was the busiest day of the week, with the highest number of attendances arriving between 11:00 and 12:00am. Sunday was the least busy day of the week.

There were 2,581 daily attendances on average each Monday during December 2019, whilst the lowest average number of daily attendances was on a Sunday (1,833).

Arrivals at EDs by Hour and Day of Week

GP Referrals

During December 2019, 17.9% of attendances at EDs had been referred by a GP. Across Type 1 EDs, Antrim, Ulster (24.8%, 24.8%) reported the highest percentage of ED attendances referred by a GP, whilst Altnagelvin (13.4%) reported the lowest.

Since April 2014, the percentage of ED attendances which had been referred by a GP ranged from 13.2% in August 2014 to 19.9% in January 2018.

GP Referrals to EDs

Left Before Treatment

During December 2019, 4.8% of attendances left an ED before their treatment was complete. Across Type 1 EDs, Mater (10.6%) reported the highest percentage of ED attendances leaving before their treatment was complete, whilst Antrim (2.1%) reported the lowest.

Since April 2014, the percentage of attendances leaving an ED before their treatment was complete ranged from 2.8% in June 2017 to 5.8% in November 2019.

Patients Leaving ED Before Treatment Complete

Waiting Times at ED

Four Hours

During December 2019, 54.8% of patients attending Type 1 EDs in Northern Ireland were treated and discharged or admitted within four hours, 7.4% less than December 2018 (62.2%). Information is also detailed in the heatmap below on the monthly performance against the four hour ED waiting times target each month from April 2008.

Heatmap of Performance against Four Hour Target at Type 1 EDs

During this period, the RBHSC (76.7%) reported the highest performance of any Type 1 ED, whilst Craigavon reported the lowest 44.5%.

The table below details the number of attendances and performance against the four hour target at Type 1 EDs during December 2019 compared with December 2018.

Performance against Four Hour Target at Type 1 EDs

	Attendances		Four Hour
Department	Attendances	Change Att.	% within 4 hrs	Change 4 hrs	Target Achieved
Mater	3,789	-288	54.7	-15.5	No
RVH	7,659	-465	45.7	-9.1	No
RBHSC	3,605	-155	76.7	0.2	No
Antrim	7,451	206	60.7	2.2	No
Causeway	3,988	197	66.8	-6.5	No
Ulster	7,888	-328	54.9	-3.5	No
Craigavon	6,638	-559	44.5	-9.7	No
DaisyHill	4,548	-42	60.2	-5.1	No
Altnagelvin	5,290	-498	46.4	-20.8	No
SWA	3,179	164	51.1	-12.2	No

Since April 2014, the percentage of patients treated and discharged or admitted within four hours ranged from 54.1% in Nov 2019 to 91.2% in Aug 2008.

Performance against Four Hour Target at Type 1 EDs

The figure below presents a further analysis of waiting times at EDs, by presenting the number of patients waiting in each 20 minute time period from zero to 24 hours. The four hour target is marked on the chart in red.

During December 2019, there is a notable fall in the percentage of patients attending EDs who were discharged / admitted in the 20 minute period immediately before breaching the 4 hour target (4.9%, 3,111) and the 20 minute period immediately after the 4 hour target (3.1%, 1,997).

Time Waited in ED from Arrival to Discharge, by 20 Minute Period

Twelve Hours

During December 2019, 5,230 patients waited over twelve hours in Type 1 EDs in Northern Ireland, 3,250 more than December 2018 (1,980).

In December 2019, the Ulster (985) ED reported the highest number of patients waiting over 12 hours at any Type 1 ED, whilst the RBHSC reported the lowest (1).

The table below details the number of attendances and performance against the twelve hour target at Type 1 EDs during December 2019 compared with December 2018.

Performance against Twelve Hour Target at Type 1 EDs

	Attendances		Twelve Hours
Department	Attendances	Change Att.	Over 12 hrs	Change 12 hrs	Target Achieved
Mater	3,789	-288	265	215	No
RVH	7,659	-465	711	502	No
RBHSC	3,605	-155	1	1	No
Antrim	7,451	206	802	422	No
Causeway	3,988	197	342	270	No
Ulster	7,888	-328	985	375	No
Craigavon	6,638	-559	881	599	No
DaisyHill	4,548	-42	331	217	No
Altnagelvin	5,290	-498	637	505	No
SWA	3,179	164	275	144	No

Since April 2008, the number of patients waiting over 12 hours at Type 1 EDs ranged from 1 in Sep 2008 to 5,230 in Dec 2019.

Performance against Twelve Hour Target at Type 1 EDs

Time to Triage

The length of time patients waited from the time of their arrival at an ED to their triage by a medical practitioner, includes a brief history, pain assessment and early warning scores, for all patients. Two aspects of the time waited are reported, including:

the 95th percentile, which is the time below which 95% of patients were triaged each month; and,
the median waiting time, which is the time below which 50% of patients were triaged.

During December 2019, the median waiting time from arrival to triage was 10 minutes, 1 minute longer than the time taken in December 2018 (9 minutes), whilst 95 per cent of patients were triaged within 46 minutes, 9 minutes longer than the time taken in December 2018 (37 minutes).

Time from Arrival to Triage

The Altnagelvin (18 minutes) reported the longest median waiting time of any Type 1 ED during December 2019, whilst DaisyHill (5 minutes) reported the shortest median waiting time.

During December 2019, RVH (66 minutes) reported the longest time taken to triage 95 per cent of attendances, whilst DaisyHill (15 minutes) reported the shortest time.

Time to Start of Treatment

The length of time patients waited for their treatment to start following triage (initial assessment) by a medical practitioner is presented below. The start of treatment refers to the begining of a definitive treatment by a decision-making clinician. Two aspects of the time waited are reported, including:

the 95th percentile, which is the time below which 95% of patients commenced treatment each month; and,
the median waiting time, which is the time below which 50% of patients commenced treatment.

During December 2019, the median waiting time from triage to start of treatment was 51 minutes, 5 minutes longer than the time taken in December 2018 (46 minutes), whilst 95 per cent of patients commenced their treatment within 276 minutes, 32 minutes longer than the time taken in December 2018 (244 minutes).

Time from Triage to Start of Treatment

Do Patients Admitted Wait Longer?

Information detailed below is presented on the total waiting time for patients, (i) admitted to hospital or (ii) discharged home. The time waited refers to the time from arrival in ED until the patient leaves the ED to be discharged home or admitted to hospital.

Patients admitted to hospital continue to wait longer in an ED than those discharged home. During December 2019, the median time patients admitted to hospital spent in an ED was 8 hours 48 minutes, 6 hours 8 minutes longer than the median time waited by patients discharged home (2 hours 40 minutes).

Median Time Spent in an ED for those (i) Admitted and (ii) Discharged Home

Guidance

Technical Notes

Readers should note technical notes and guidance available for the information detailed in this statistical brief. This includes information on the:

Data collection;
General guidance on using the data;
Types and categorisation of EDs;
Data quality and contextual information;
Comparisons with UK; and,
Information on National Statistics publications.

Reader Information

This statistical report presents information on the time waited in emergency care departments (ED) in Northern Ireland. It also includes information on: time to triage, age and time of day of ED attendances, GP referrals, emergency admissions, patients leaving before treatment complete, triage level assessed, time to start of treatment, time waited for patients admitted and not admitted, though this information is not National Statistics, it has been included to provide users with a more comprehensive view of emergency care activity and waits.

Authors

Sarah Brown;
Kieran Taggart;
Michael O’Donnell;
Siobhan Morgan.

Issued By

Hospital Information Branch
Information & Analysis Directorate
Department of Health
Stormont Estate
Belfast
BT4 3SQ

Contact Information

We invite you to feedback your comments on this publication to Sarah Brown.
Email: sarah.brown@health-ni.gov.uk

Statistical Quality

Information detailed in this release has been provided by HSC Trusts and was validated by Hospital Information Branch (HIB) prior to release. Further information on the data included in this statistical release is available at: technical notes and guidance

Target Audience

DoH, Chief Executives of HSC Board and Trusts in Northern Ireland, Health Care Professionals, Academics, HSC Stakeholders, Media & General Public.

Using Interactive Charts

Options to interact with the charts are available in the top right corner when you hover over each chart / infographic. Each chart will have a number of optional functionality built in, including:

Hover

Hovering over a chart line or column will display the values for that month. In addition to this, if you select the icon with 2 horizontal lines in the charts pop-up toolbar, and then hover over the chart, it will display the values for each line for each month. To remove the option to view data for all lines, select the single horizontal line on the pop-up too-bar.

Focus on Shorter Period of Time

By highlighting a specific area of the chart, i.e. April 2014 to September 2015, will change the view of the chart to only present the data for that selected period. To view the entire chart again, simply double click anywhere on the chart.

Snapshot

On the pop-up toolbar, there is a snapshot function to allow users to take a snapshot of the chart or selected months, that can then be used as a static image.

Spike Lines

On the pop-up toolbar, the spike function enables users to hover over a line and it will display a line parallel with both the x and y axis, that shows the x and y axis value at the point on the line you have focused on.