This paper sets out how we used Hospital Episode Statistics (HES) to explore measures of A&E departments’ performance and, in particular, their association with measures of bed pressure.

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Our previous report on Emergency admissions to hospital discussed the relationship between performance against the 4‑hour A&E standard and admission patterns. It showed that a quarter of emergency admissions from A&E departments occur within the last 10 minutes of this 4‑hour period. This suggests that delaying admissions until the end of the 4‑hour period could be a mechanism for managing limited bed capacity.

A recent trend of declining performance against the A&E 4‑hour standard has been documented nationally. Constraints to patient flow across a hospital have been one of the potential causes cited. However, it is unclear if bed pressure is undermining wider measures of A&E performance.