Impact of junior doctor strikes on patient flow in the emergency department: a cross-sectional analysis

Abstract

Background and importance Healthcare worker strikes are a global phenomenon. Mortality and morbidity seem to be unaffected by doctor strikes, but there is little evidence on the impact on emergency department (ED) flow and patient characteristics. In March and April 2023, two consecutive UK junior doctor strikes occurred. Objectives This study investigated the impact of junior doctor strikes on ED patient flow. Additionally, variation in patient presentations was compared between non-strike and strike days. Design, setting and participants This cross-sectional study was conducted at King’s College Hospital ED, a university hospital in London. All ED attendances during the 72- and 96-hour strike actions were compared with the corresponding non-strike days of the previous week. Outcome measures and analysis National key performance indicators (KPIs) were analysed and compared between non-strike and strike days. Patients’ demographics, acuity and diagnoses were compared. Outcome measures included number of 4-hour breaches, number of patients admitted or discharged and ED mortality. Staff seniority was categorised into levels for analysis. Main results There was increased ED patient flow during strike days with a significantly shorter total time in department in March [240 min (IQR 155–469) vs. 286 min (IQR 198.5–523.5), P < 0.001] and in April [222.5 min (IQR 147–351) vs. 251.5 min (IQR 174–443), P < 0.001]. Time to first clinician, treatment, and decision to admit were all shorter during both strike actions. Number of attendances, acuity, diagnoses, admission, discharge, and mortality rates were similar during strike and non-strike days. Staffing numbers were lower or equivalent on strike days but level of seniority was higher (P < 0.001). Conclusion The improved KPIs and increased patient flow during strike days, while multifactorial, seem largely attributed to the higher number of senior staff. Patient presentations and outcomes were unaffected by junior doctor strike action.