{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T18:26:42Z","timestamp":1793730402875,"version":"4.6.1"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Planning &amp; Management"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The NHS is now facing serious challenges from acute care pressure, reflecting on the emergency department (ED) national waiting time target compliance. Concerns about cancelling elective operations to cope with emergency services have also arisen. However, there is a lack of existing evidence to prove a direct relationship between ED episodes and planned hospital services. Thus, the objective of this study is to investigate the impact of high ED attendances on elective surgical activities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cross\u2010sectional observational study which includes the five largest health boards in NHS Scotland. All patients who presented to the ED in 2021 are included. Univariate and multivariate regression analysis were used to show relationship between ED attendances and elective surgical services including in\u2010 and out\u2010patient waiting lists and clinic activities. Explanatory variables include total ED attendances and attendances that exceeded the national waiting time target.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The five health boards recoded a higher patient visit to ED on second and third quarter. Non\u2010compliances to 4\u00a0hours waiting time ranges between 6% and 20%. Both Univariate and multivariate regression analysis showed a positive correlation between long ED waiting time (&gt;\u00a08 and 12\u00a0hours) and increased patient waiting time for elective surgical service as well as delay in clinic review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Prolonged ED waiting times were consistently associated with delay in in\u2010 and out\u2010patient elective service. To ensure timely and adequate treatment of patients, policymakers should invest in resources to improve the efficiency of both emergency and elective services and introduce management plans that balance the needs of both services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hpm.70124","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T18:24:47Z","timestamp":1788805487000},"page":"1246-1256","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Prolonged Emergency Department Waiting Time on Elective Surgical Activities: A Cross\u2010Sectional Observational Study in National Health Service (NHS) Scotland"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7811-5948","authenticated-orcid":false,"given":"Jia Jin","family":"Kwong","sequence":"first","affiliation":[{"name":"University Hospital Wishaw  Wishaw Lanarkshire UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1348-2366","authenticated-orcid":false,"given":"Kawan","family":"Shalli","sequence":"additional","affiliation":[{"name":"University Hospital Wishaw  Wishaw Lanarkshire UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"The NHS at 70: How Good Is the NHS? The Nuffield Trust","author":"Dayan M.","year":"2018"},{"key":"e_1_2_10_3_1","volume-title":"Transforming Emergency Care in England","author":"Alberti G."},{"key":"e_1_2_10_4_1","unstructured":"Government of Western Australia.Four Hour Rule Program http:\/\/www.health.wa.gov.au\/fourhourrule\/home\/."},{"key":"e_1_2_10_5_1","unstructured":"Ministry of Health New Zealand. \u201cRecommendations to Improve Quality and the Measurement of Quality in New Zealand Emergency Departments \u201d http:\/\/www.moh.govt.nz\/moh.nsf\/pagesmh\/8783\/$File\/quality\u2010ed\u2010jan09.pdf."},{"key":"e_1_2_10_6_1","volume-title":"Clinical Exceptions to the 4 H Emergency Care Target","author":"Department of Health","year":"2003"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12873\u2010021\u201000438\u2010y"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0203316"},{"key":"e_1_2_10_9_1","volume-title":"A&E Waiting Times","author":"Trust N.","year":"2023"},{"key":"e_1_2_10_10_1","volume-title":"Public Satisfaction With the NHS and Social Care in 2021: Results From the British Social Attitudes Survey","author":"Wellings D.","year":"2021"},{"key":"e_1_2_10_11_1","unstructured":"House of Commons Health Committee. \u201cWinter Pressure in Accident and Emergency Departments Third Report of Session 2016\u20132017 \u201d https:\/\/publications.parliament.uk\/pa\/cm201617\/cmselect\/cmhealth\/277\/277.pdf."},{"key":"e_1_2_10_12_1","volume-title":"What Caused the Uk's Elective Care Backlog, and How can We Tackle It?","author":"Mallorie S.","year":"2023"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.2849"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102017\u2010020296"},{"key":"e_1_2_10_15_1","unstructured":"Scottish Health and Social Care Open Data (Internet). \u201cPublic Health Scotland; Datasets\u2010 Scottish Health and Social Care Open Data \u201d https:\/\/www.opendata.nhs.scot\/dataset."},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2004.015081"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2006.11.007"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2008.03.014"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326\u20105377.2006.tb00204.x"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2004.05.004"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735\u20106757(94)90135\u2010x"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.3310\/hsdr04030"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102016\u2010015007"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1503\/cjs.008119"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10729\u2010007\u20109035\u20106"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1503\/cjs.019711"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/QMH.0000000000000236"},{"key":"e_1_2_10_28_1","volume-title":"The Case for Surgical Hubs","author":"Royal College of Surgeons"}],"container-title":["The International Journal of Health Planning and Management"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hpm.70124","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hpm.70124","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hpm.70124","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:30:44Z","timestamp":1793727044000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hpm.70124"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":27,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["10.1002\/hpm.70124"],"URL":"https:\/\/doi.org\/10.1002\/hpm.70124","archive":["Portico"],"relation":{},"ISSN":["0749-6753","1099-1751"],"issn-type":[{"value":"0749-6753","type":"print"},{"value":"1099-1751","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]},"assertion":[{"value":"2024-07-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}