Hospital Dr News

College outlines worsening winter pressure on A&Es and the solutions

Patient demand, lack of hospital capacity and poor patient flow are to blame for deteriorating performance in Emergency Departments, a report concludes.

The report, by the Royal College of Emergency Medicine, examines why A&E departments are increasingly struggling each winter.

In the last five years, annual attendances to A&E have risen by around 611,000 per annum.

The report, called ‘Why does winter in A&E get worse every year?’, also shows that there has been a disproportionate increase in admissions – 75% of the attendance increase.

The College says that redirection and re-education strategies have largely failed.

Not only has the four-hour standard performance declined but the rise in 12-hour trolley waits has increased by 200% in the last 3 years.

Slow discharge from the hospital and reduced flow through the emergency department impedes the accommodation of new attendances. In turn there is a consequent deterioration in ambulance off-load times, the report says.

A significant proportion of patients attending an A&E department can be managed at least as well if not better by other services/staff. Data from the Royal College of Emergency Medicine Sentinel Sites study published in 2014 shows that more than a third of attendances could be managed without input from an EM doctor.

It also calls for the co-location of key out-of-hours urgent care services.

Eight out of ten A&E attendances are by people who live within 7.5 miles of a major A&E department.

A co-located model – in which key components of urgent healthcare are physically and functionally co-located to allow the alignment of behaviours with resources – is partially implemented in some sites already and has huge potential for collaborative working with better patient focused service provision.

Dr Clifford Mann, President of the Royal College of Emergency Medicine, said: “The report shows just how great the pressure on A&Es is over winter. We have been campaigning to improve emergency care for five years but these data unambiguously show the need to decongest emergency departments and resource them to meet current and future challenges.

“Over two decades the cumulative effect of under investment, failure to acknowledge annual trends, inadequate tariffs and wishful thinking have left the system inadequate to the task.

“Our STEP campaign aims to build a consensus to address the fundamental challenges faced i.e. sustainable staffing, tariff reform and contract terms that support a work-life balance, the eradication of exit block and co-location of primary/urgent care services.”

The report also highlights the burden of respiratory disease in the winter months on A&E.

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