The number of patients dealt with in the last 20 minutes of the four hour accident and emergency target window has increased to more than 40 per cent, a group of emergency care doctors have found.

Analysing hospital episode statistics data for 2008-09 they found that in the last 20 minutes of the four hour target 31 per cent of patients were admitted from the emergency departments of English hospitals, and 11 per cent were discharged.

The same team, from Barnsley District Hospital Foundation Trust and Sheffield University, found the equivalent figures in 2004, when the A&E target was for 90 per cent of patients to be treated within four hours, showed 12 per cent of patients were admitted and 3.6 per cent were discharged.

Since 2005 the A&E target has been to treat 98 per cent of patients. This has recently been relaxed to 95 per cent, with expectations that it will be replaced next year with a dashboard of clinical indicators.

In a letter to the BMJ, the doctors said the four hour target had produced target led care.

They wrote: “Although many in the specialty of emergency medicine support the benefits [of the target], these results suggest that they are not being experienced by all patients, and that processes throughout the hospital and wider healthcare system may not have improved to accommodate it.”