Abstract

The purpose of this article is to analyse and understand the capacity of a district general hospital to meet its demand for emergency care and achieve the four-hour wait performance target: to ensure that patients should not ‘wait more than four hours in an [Emergency Department] from arrival to admission to a bed in the hospital, transfer elsewhere or discharge’ (Department of Health, 2001). The research adopts a mixed methods case study design. Quantitative data from staff rotas, and resource availability and qualitative data from an ethnographic study are combined to evaluate the effect capacity provided has on performance. The article concludes that the framework adopted by the case site provides insufficient capacity planning to meet patient demand and has contributed to performance levels below target expectation. Departmental and managerial barriers obstruct timely movement of patients and this frequently leads to reactionary activities to meet performance targets.