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Time to tackle ‘exit block’ in A&E units

Urgent action is needed to address ‘blocked’ A&E departments, the College of Emergency Medicine has said.

A new situation called ‘exit block’ is affecting a growing number of hospital A&Es, putting patients at risk.

Exit block occurs when emergency doctors can’t get patients from A&E into a hospital inpatient bed. Over 500,000 patients a year are affected, the college estimates, and says that this is unacceptable.

They’re calling on hospital CEOs and their boards to make sure that this issue is on their agenda.

To help tackle this issue the college has issued guidance: Crowding In Emergency Departments (see summary below). NHS England and Monitor, the Trust Development Association have endorsed this in their own winter planning guidance for this coming winter.

President of the College of Emergency Medicine Dr Clifford Mann said: “We are concerned with patient safety. When the A&E becomes crowded because of exit block we know that patients do less well. We know that crowding kills.

“This is such an important issue. It is about the flow of patients from ambulances, through A&Es and into hospital wards. The simple fact is that crowding kills. It is simply not acceptable to let this situation continue which is why we are speaking out to urge hospital senior management to make sure they have plans to deal with this issue.”

The college and Urgent Health UK recently teamed up to call for a change to the tariff system which penalises emergency departments when they try to develop effective arrangements with primary care.

They endorse the co-location of primary care teams with emergency departments but emphasise that the payment system is hampering progress.

Summary of recommendations

1. Emergency Department capacity should be capable of meeting demand.

2. Non-Emergency Department staff should not ‘gatekeep’ access to the Emergency Department.

3. A patient who attends an Emergency Department is entitled to an assessment by a clinician.

4. Emergency Departments should have systems that can monitor the degree and impact of crowding.

5. Streaming patients does not help with Emergency Department crowding if the cause of crowding is inadequate hospital capacity.

6. Investigations should be ‘front loaded’ to reduce delay to disposition decisions.

7. Senior doctors of all specialities should be involved with rapid assessment and treatment.

8. Hospitals with Emergency Departments should have a hospital wide escalation policy for when the Emergency Department becomes crowded

with locally agreed triggers.

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4 Responses to “Time to tackle ‘exit block’ in A&E units”

  1. Malcolm Morrison says:

    Also, there needs to be an ‘Emergency Admissions (Observation)’ ward in ALL hospitals accepting ’emergencies’ – where patients can only stay for 24 hrs. GPs should be allowed to arrange emrgency admissions DIRECTLY with a specialty dept. by discussing it over the phone with a member of the specialist team – thus ‘by-passing’ A&E

  2. bellend Steth says:

    That is already the case isn’t it Malcolm? There is the Clinical Decisions Unit (the other part of A and E with a curtain pulled across to avoid the 4 hour breach). GPs can and do arrange direct admissions to wards. You aren’t suggesting anything new.

  3. Aram says:

    I would like to see where bellend works!!!
    GP admission to wards directly is a myth.
    I haven’t seen it happening for the past 10 years and I have worked in different Trusts.

  4. Nick says:

    Exit block is not new. In fact this article feels as if it was written in the mid 90s when I started in ED. None of the recommendations are new or indeed helpful, sorry; it’s actions that have been apparent within emergency dept management for decades.

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