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“The A&E target” and thoughts about why we’re struggling to meet it. A thread
First let’s clear up what the target is- 95% of all patients will be seen, treated and discharged or admitted into a hospital inpatient bed within four hours. Not just treated. Not just assessed. The whole thing. 2/
Has “demand” gone up- yes, most definitely. Most Emergency Departments (the international name for A&E) have seen at least a 7-10% year on year increase. Some of these are “low acuity” (ie not that sick), but not many. 3/
We have increased the doctors, nurses and other clinicians, but not at the rate needed to keep up. We are also doing more and more with every patient often “just to be safe”. Patients expect this, but so do lawyers (anecdotally) and the media. We simply can’t “miss” anything. 4/
This added expectation has meant we see about 1 patient per hour per clinician. Doesn’t sound like much I know, but we don’t work in the same way as GPs (partly for the reasons above). 5/
The added pressure in 4/ means we are also admitting more patients, yet the number of inpatient beds has gone down. We’ve worked hard to reduce length of stay, but some patients are bouncing back. Where do they bounce back to? The ED. 6/
As we try to get more patients out of hospital sooner, social care simply isn’t geared up to look after then. People are living longer, with more complex conditions and need more care. If we can’t discharge patients, then those in ED can’t get to beds 7/
On top of this ED doctors are tiring of the workload and looking to other places for income. They are decreasing their hours. Very few A&E consultants work “full time” in the ED. The pension tax issue has worsened this. 8/
So, we have too many patients, expecting too much, with lawyers and the media watching us closer than ever, clinicians who are more risk adverse than ever, in departments that were simply not designed to deliver this service 9/
What can be done? A few ideas...
1, Really make Emergency Departments about Emergencies. Co locate other services by all means, but EDs can no longer just see everyone who turns up, with ever expanding queues 10/
1, Really make Emergency Departments about Emergencies. Co locate other services by all means, but EDs can no longer just see everyone who turns up, with ever expanding queues 10/
2, Set realistic expectations. Is four hours right for all conditions? Tell the public what is reasonable. Invest in primary care to enable them to have time to fulfil their vital role looking after those with chronic illness, but also treating those who don’t need hospital 11/
3, Design and build hospitals that are able to function efficiently and effectively in the 21st century. Put all emergency/acute areas together, to enable closer working between specialties. 12/
4/ Work with Ambulance Services to redirect patients where possible. Not token gestures, but proper support. Ask hospitals to have a “Directory of Services” that paramedics can access for emergency outpatient appointments or consultations with patients’ specialists. 13/
5/ Invest in social care. This needs a complete rethink. Should hospitals manage nursing homes and work most closely with them? 14/
6/ Invest in support staff that unburden clinical staff. People to answer the phone, take messages, check bed availability. Make the IT work 15/
6/ Invest in support staff that unburden clinical staff. People to answer the phone, take messages, check bed availability. Make the IT work 15/
Lastly. Be honest about the problems. Listen to the experts. Don’t regurgitate soundbites. What A&Es are living with day to day simply shouldn’t be acceptable and we should be embarrassed. And value the staff. They are the only ones keeping this afloat at the moment. Ends/
