A new study into the volume of patients who are admitted to hospital as an emergency while waiting for their surgery has now been published – reinforcing the importance of GIRFT’s ongoing work to support providers to drive down waiting times.
Published in the British Journal of Surgery, the study has been carried out by a team of GIRFT and NHS England colleagues* as the first large scale analysis of emergency admissions in England occurring while patients are waiting for an elective procedure.
It finds that many patients on elective procedure waiting lists are admitted to hospital during their wait for reasons that could be avoidable if they had been treated earlier. It also suggests that a prioritisation exercise may be worthwhile to determine which cohorts of patients (other than those in need of cancer surgery) are most at increased risk of harm while waiting for their procedure.
Professor Tim Briggs, GIRFT programme lead and NHS England National Director for Clinical Improvement, Elective Recovery and UEC, said:
“Currently, surgical waits for cancer are prioritised, as well as patients on other pathways who may be prioritised according to guidance and at the discretion of their clinicians, but there is no mechanism for prioritisation between care pathways and no mechanism to adjust targets for specific procedures based on risk of harm.
Just as cancer patients were prioritised during and following the COVID-19 pandemic, it may be time to consider prioritisation for other procedures and patient groups with a risk of waiting list harm.
This study shows that the key work GIRFT is doing – improving our use of outpatient clinical time with standardisation of clinical templates, supporting elective hubs, sharing best practice for increasing day case surgery and reducing length of stay, and freeing up beds for patients who need them most – is more important than ever.”
Titled Emergency hospital admissions whilst on an elective waiting list in England, the study was carried out in the context of figures from July 2024 showing there were 6.4m patients waiting for 7.6m treatments in England – a figure which was heavily exacerbated by the suspension of elective activity during the COVID-19 pandemic.
The research group looked at hospital admissions for the two calendar years of 2022 and 2023, identifying all patients admitted to hospital as an emergency while waiting for treatment.
Just over 2m procedures were identified on the waiting list for 41 selected procedures in 11 specialties – these were predominately high-volume surgical interventions. During a combined waiting time of 33.8m days, there were around 69,000 emergency admissions involving close to 536,000 bed days.
Emergency admissions per 52-week wait were highest for:
- urinary stent procedures (0.71)
- endoscopic retrograde cholangiopancreatography (0.63)
- urinary catheter care procedures (0.55)
Significantly, nine procedures had more emergency bed days during the wait than elective bed days for the procedure once delivered, with the highest ratio of emergency/elective bed days observed for:
- ureteric stones (4.59)
- colonoscopy (2.80)
- ablation/cardioversion (2.05)
Professor Briggs added:
“Our study clearly demonstrates the variation in clinical risk of adverse events while patients are on the waiting list and variation between specialties and between procedures, which raises important questions about how best to manage these risks while we continue to reduce waiting lists for all patients.
It may be necessary to prioritise these high-risk pathways beyond the level of the routine.”
*The GIRFT colleagues who authored the study are:
- Anthony James – senior analytical lead
- William Gray – academic content lead
- Mark Cheetham – GIRFT clinical lead for general surgery
- Mark Lansdown – GIRFT clinical advisor for endocrinology
- Ian Eardley – NHS England national clinical director of elective care recovery
