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| waits & measures Improving emergency care for today’s patients October 2002 |
Summary
1. A survey of accident and emergency (A&E) departments in the UK was undertaken jointly by the British Association for Accident and Emergency Medicine and the British Medical Association in July 2002. The aim of the survey was threefold:
- to provide a realistic assessment of current pressures in A&E
- to share innovative practice
- to make recommendations for reform.
3. The NHS plan target of a maximum 4 hour wait between arrival and the decision to admit disguises the problem of long waits faced by patients between the decision to admit and finding a bed on a ward. Respondents were particularly concerned with the increasing use of A&E departments to ‘warehouse’ these patients. This practise meant that the space and staff needed to see and treat A&E patients was taken up seeing to the needs of admitted patients. Nurses were said to be concerned with the unsatisfactory care received by admitted patients in these circumstances.
4. The survey found many examples of innovative practice in A&E departments that had brought about service improvements.
5. Service improvements frequently occurred when staffing levels had Increased.
6. Where departments had improved waiting times, an important factor had been a trust-wide approach by managers.
7. The single most important step for improving waiting times in A&E was considered to be increasing the availability of in-patient beds. This could be achieved by:
- keeping bed occupancy in hospitals below 85%
- having a senior medical presence in the department at all times so as to prevent unnecessary admissions
- improving the funding and provision of community care so as to (i) prevent unnecessary attendance at the A&E department and (ii) reduce delayed discharges
Introduction
People expect that in an emergency they will be seen promptly on arrival to their local A&E department from where, if necessary, they will be transferred without delay to a hospital bed. The attention surrounding recent cases where elderly patients have spent several days in the A&E department reflects the depth of public concern over long trolley waits, and the belief that these are symptomatic of an NHS that is failing or operating at a ‘third world’ standard.1
This report looks at the current situation, what is being done and what needs to be done to improve waiting times in A&E.
Structure of report
Chapter one gives the background to the survey by describing the current situation in A&E departments in the UK. It also looks at what policy responses have been proposed by the government and what recommendations have been made by other relevant organisations. Chapter two contains the results of the survey and chapter three discusses the results of the survey and their implications for policy.
References
1 Carvel J Nurse recounts indignity of dead in ‘third world’ NHS. The Guardian, Tuesday April 23, 2002.
To download a PDF of the report, click here:
(1952 kb)