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Survey shows record numbers admitted via A&E

Four hour waiting targets missed due to overload in all departments and delayed discharges

Mark Gould

Thursday, 03 September 2015

An increase in A&E waiting times last winter was due to higher rates of occupancy in all other hospital departments and delays in discharging patients according to a major review by the health regulator Monitor.

Trusts told Monitor that problems with social care were the main cause of the delays, with a 27% increase in delayed handover of patients from hospital departments to social or community care.

However, the review did not find that inappropriate A&E attendances caused waiting times to exceed four hours. It found that there was an increase in the number of people who went to A&E, but that A&E departments "coped well" with this added demand. Delays occurred when patients needed to be admitted to other hospital departments from A&E but had to wait in A&E because the wards were full.

Delays were also caused as a result of more patients being admitted to other hospital departments from A&E last winter than the winter before. The review found that this, combined with the capacity issues in those departments, contributed to the longer waits.

And a 7% increase in ambulance attendances also contributed to delays as A&E departments usually need to see patients who come in by emergency ambulance before those already waiting.

Monitor says it found no difference in admission patterns last winter than in previous years. "We found patients went to A&E departments almost on the same day of the week and time of the day as they did last winter.”

And it says that there was no evidence to suggest that A&E staffing issues contributed to the national delays last winter. "In fact we believe that A&E departments had more staff available and the ratio of junior to senior doctors was stable in this period."

Some trusts reported longer waits to access specialist or diagnostic services from other departments, but this was not found to be a cause of the national delays.

The survey also found that while levels of sickness are hard to measure, it found no real difference from the winter before. “We found that the number of beds available to A&E departments nationally remained about the same. The challenge was finding an appropriate bed in the rest of the hospital for patients who needed one,” says Monitor.

In an attempt to tackle these pressure points, Monitor says the National Institute for Health and Care Excellence (NICE) is currently developing service guidance on ‘Acute medical emergencies in adults and young people’, which will cover service organisation and delivery across the NHS. Monitor will also publish research on moving healthcare closer to home, which includes an assessment of the impacts and provides examples of schemes that could improve patient flow.

The Royal College of Emergency Medicine says the report reiterates the findings of the College and its submission to the Commons Health Select Committee in January. College president Dr Cliff Mann said:

“The endorsement by Monitor of the College’s analysis of winter pressure and the recognition that without the four hour standard patient care would be immeasurably worse highlights the value of our STEP campaign. This campaign, launched last winter, seeks to address the very issues at the core of Monitor’s analysis. In particular the eradication of ‘Exit Block’ which results in patients who need admission waiting for many hours for a hospital bed is a proven cause of avoidable deaths and unacceptable consequences for patient care.

"In addition the need to decongest the emergency department by providing co-located urgent out-of-hours primary care services is essential to ensure emergency departments are not overwhelmed.”

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