The Royal College of Emergency Medicine (RCEM) has issued a statement to say that it strongly believes that the four-hour standard is a vital measure of performance and safety.
It stated that it is important that at least 95% of all patients attending emergency departments (EDs) are seen and discharged or admitted within four hours.
Many departments are now struggling with performance against the four-hour standard and RCEM’s data show a system under acute distress. Some 40% of the hospitals in England taking part in RCEM’s Winter Flow programme are reporting less than 75% using the fourhour performance measure. This results in significant crowding and heightens the risk of safety being compromised.
RCEM also said that, while there is no suggestion of removing the four-hour standard in the short term, action must be taken to ensure decisions are not being made to simply improve the numbers rather than delivering quality patient care.
Data show that in the space of four years the number of 12-hour trolley waits have trebled. However, RCEM claims that the numbers being reported underestimate the problem. It called for the clock to start ticking from when the patient arrives at the emergency department rather than from when a decision is made to admit the patient. Other nations in the UK report the data from arrival.
Dr Adrian Boyle, chair of the Quality Emergency Care Committee at the Royal College of Emergency Medicine (RCEM), said: “The disparity between the NHS England method in recording 12-hour breach data and the actual time that patients wait is startling. This data should be reported from the point a patient arrives at the ED, not as is the case at present, from the decision to admit to admission.
“The data is not just about tedious waits for patients, but about safety. Studies have repeatedly shown that there is an increased mortality in people who spend a long time in emergency departments; crowding kills patients.It is so important that data is correctly captured and that it truly reflects performance as it helps to ensure patient safety.”
President of the Royal College of Emergency Medicine, Dr Taj Hassan, said: “The College, based on its own work, believes that only 15 to 20% of emergency department patients could be seen in other healthcare services provided capacity exists. At present, there is a lack of sufficient alternatives – with patients frequently having to wait a long time to see a GP – so patients quite naturally go to their emergency department. One solution to this is to co-locate services around the ED, to allow for the correct ‘streaming’ of patients.
“The current situation is also exacerbated by social care cuts, with many hospitals struggling to discharge patients who are well enough to leave but who do not have a care package in place. Those vulnerable patients who are discharged without aftercare in place often end up back in hospital. This means that full hospitals have patients queuing at the front door; that is why there are trolley waits at emergency departments.
“The ‘elephant in the room’ is a lack of beds in the community and the acute care setting. This coupled with an inadequate number of ED staff to cope with current demand are at the root of this crisis. A correction of the funding to both social care and emergency medicine is the best long term solution.”
