10 October 2019
The new President of the Royal College of Emergency Medicine, Dr Katherine Henderson, today provides an update on the College’s position on and involvement in the review of urgent and emergency care standards.
Dr Henderson said: “We are engaged with the review. The four-hour access standard has driven significant beneficial changes in the delivery of emergency care for most patients since it was introduced with the aim of addressing the long waits experienced by patients. The standard should only be replaced by something that maintains the benefits it has delivered, whilst improving on its failings. In particular, any new metric should reduce the bureaucracy the current performance regime has created.
“The overall system is under huge pressure and patients are being failed. Occupancy in hospitals is high and access to community beds is limited. For emergency patients, getting into a hospital bed in a timely way has become more challenging. Patients needing admission to hospital end up staying too long in Emergency Departments, which are becoming more and more crowded. Patients end up being moved out of cubicles and into the corridor so that departments can continue to function. There is little evidence that a patient who requires admission to hospital benefits from being in the Emergency Department beyond four to six hours. Common sense tells us that it is better to be in a hospital bed on a ward, than a trolley in an Emergency Department corridor.
“For patients staying more than four hours, the next standard in England has been the requirement to admit patients within 12 hours of the Decision to Admit (DTA). It has been possible to apply the rules about this in a variety of ways – with the result that the official figure of 12-hour DTA breaches significantly misrepresents the number of patients staying more than 12 hours. This is wrong. Many departments find themselves looking after a ward’s worth of patients in their corridors as well as providing acute care to new EM patients. Getting patients out of ambulances and into the department becomes harder and harder. Corridor care on trolleys risks becoming normalised, harms patients and is awful for staff. The review has accepted that something needs to be done for these patients. We embrace the opportunity to shine a light on those patients who have unacceptably long waits in the Emergency Department before getting to a bed. We need to draw a line under the unintended consequences of the DTA process measurement point and sort out the ED crowding damaging our ability to care for patients. The opportunity to review the metrics and look at how we can drive improvements around initial assessment is something we are keen to do. However, we will continue to advocate the four-hour standard for the majority unless there is good evidence of patient benefit from any change.”