ObjectiveTo quantify the effect of intrahospital patient flow on emergency department (ED) performance targets and indicate if the expectations set by the National Health Service (NHS) England 5-year forward review are realistic in returning emergency services to previous performance levels.DesignLinear regression analysis of routinely reported trust activity and performance data using a series of cross-sectional studies.SettingNHS trusts in England submitting routine nationally reported measures to NHS England.Participants142 acute non-specialist trusts operating in England between 2012 and 2016.Main outcome measuresThe primary outcome measures were proportion of 4-hour waiting time breaches and cancelled elective operations.MethodsUnivariate and multivariate linear regression models were used to show relationships between the outcome measures and various measures of trust activity including empty day beds, empty night beds, day bed to night bed ratio, ED conversion ratio and delayed transfers of care.ResultsUnivariate regression results using the outcome of 4-hour breaches showed clear relationships with empty night beds and ED conversion ratio between 2012 and 2016. The day bed to night bed ratio showed an increasing ability to explain variation in performance between 2015 and 2016. Delayed transfers of care showed little evidence of an association. Multivariate model results indicated that the ability of patient flow variables to explain 4-hour target performance had reduced between 2012 and 2016 (19% to 12%), and had increased in explaining cancelled elective operations (7% to 17%).ConclusionsThe flow of patients through trusts is shown to influence ED performance; however, performance has become less explainable by intratrust patient flow between 2012 and 2016. Some commonly stated explanatory factors such as delayed transfers of care showed limited evidence of being related. The results indicate some of the measures proposed by NHS England to reduce pressure on EDs may not have the desired impact on returning services to previous performance levels.

Projections of the burden of KA provide a quantitative basis for future policy decisions on the concentration of high-complexity procedures, the number of orthopedic surgeons required to perform these procedures, and the resources needed.

A465 studies. Results: We estimated the indirect cost of cancer due to disability in EU at the amount of 4223.2 million EUR. However partial disability account for approx. 20-25% of this sum and reduces potential savings to the amount of 844.6-1055.8 million EUR. Further correction, taking into account the efficacy of rehabilitation programs (up to 85%), reduces this savings to 717.9-897.4 million EUR. Considering the loss of productivity due to sickness absence and presenteeism measured in cancer survivors' population (19.1% and 37.3% respectively) potential savings for EU economy due to return to work of cancer survivors with a disability are calculated at the amount of 364.2-455.2 million EUR. ConClusions: Indirect cost of cancer related disability can be reduced, but probably only to a small extent.