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Inappropriate admissions from A&E “scandalous”

BMA Scotland says admitting patients to keep to 4-hour A&E target is scandalous

Louise Prime

Thursday, 12 August 2010

Doctors and nurses in the NHS worry that the target to treat A&E patients within four hours is leading to inappropriate admissions and patients being left on trolleys in corridors, according to a new report by Audit Scotland.

Patients in Scotland are generally delighted with the care given by their emergency departments, with 80 per cent saying it’s excellent or very good, and 86 per cent rated the ambulance service similarly well, says Audit Scotland. But it found that service provision, attendance rates and data recording vary too widely across Scotland, and argues that the NHS in Scotland can do more to manage services more efficiently.

The report shows that attendance at emergency departments has increased by 9 per cent over the past 10 years. The reasons for this have not been fully analysed, hampering efforts to address the problem. Most attendances are self-referrals, but the figure varies hugely across the regions from 57 per cent to 90 per cent; GP referrals account for 10 per cent of A&E visits (ranging from 3 per cent to 22 per cent).

Despite the increase in attendances, waiting times have improved: 96% of patients are now seen within four hours compared with 83% in 2006.

More than half of staff surveyed for the report felt “that patients are moved to inappropriate areas, such as corridors, in order to meet the four-hour waiting time standard; and 70 per cent feel that there is not always enough time for patients to be adequately assessed or stabilised before being discharged or moved.”

And more than half (55 per cent) of staff “feel that patients are sometimes inappropriately admitted to hospital to avoid breaching the standard”. Only 13 per cent agreed that “there are no trolley waits in the emergency department”.

Audit Scotland says that the Scottish Government should work to improve strategic direction for emergency care services in Scotland, and clarity over the role and definitions of the various services involved in delivering emergency care.

It also recommends that NHS Boards should look at how GPs might be able to make more direct referrals to the appropriate admission unit, bypassing A&E altogether.

Dr Brian Keighley, chairman of the BMA in Scotland, said: “Reports that more than half of doctors and nurses surveyed by Audit Scotland believed that patients are sometimes inappropriately admitted to hospital to avoid breaching the four-hour waiting times target is scandalous and I would urge the Government to investigate this matter. They must also consider the issue of trolley waits, which can strip patients of their dignity.”

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