15.05.13
Urgent care ‘crisis’ – College of Emergency Medicine
Emergency departments in the UK are facing “unsustainable workloads” and their biggest challenge for over a decade, a new report by the College of Emergency Medicine warns.
The warnings have been echoed today by the Foundation Trust Network, which represents providers.
The College of Emergency Medicine report, which examines 131 emergency departments, highlighted how attendance of A&E continues to rise, and is 50% higher than ten years ago. It criticises a lack of staff and the occurrence of so-called ‘never’ events.
In 2011/12, 6% of emergency departments reported never events, which can include medical devices being left inside a patient, or surgery on the wrong part of the patient’s body.
The College argues that between 15% and 30% of patients do not need A&E care, and could instead be treated in non-emergency settings. Locating urgent care centres next to emergency departments could achieve this.
The report also recommends at least 10 full-time consultants on normal wards, instead of the average seven, and 16 on larger wards. Better methods to assess the quality of emergency departments should be used, with more using patient experience as an indicator. Currently only two fifths of departments do so.
Taj Hassan, vice president of the College of Emergency Medicine, said: “It is clear that working environments for [consultants and middle grad doctors] at times are intolerable, associated with risk for them and their patients and that action is required to stabilise our systems.
“The report has come at a timely juncture where our regulatory bodies and policy makers have also recognised this to be a crisis and suggested urgent action is merited.
“Our recommendations are based upon the need for close collaboration, system redesign, appropriate funding and sustainable working practices for care delivery and training.”
The College's president Mike Clancy added: “We must get this right. The public rightly expects that the emergency department is their ultimate safety net when they are acutely ill or injured.
“Effective clinical care means safe high-quality care seven days a week that is consistent across the UK.
“We ask for timely action by NHS England and also policy makers in Scotland, Wales and Northern Ireland to review our recommendations and collaborate with local emergency medicine experts to help solve this very serious situation.”
Norman Williams, president of the Royal College of Surgeons, said: “Action must be taken to tackle the detrimental effect of burgeoning emergency care and sometimes inappropriate admissions on the whole hospital system.”
Dr Chris Roseveare, SAM President said: “The staffing crisis in acute and emergency medicine needs to be addressed urgently. In recent months there have been many occasions when the demands on AMUs and Emergency Departments across the UK have been extreme; inadequate staffing levels have a serious impact on the quality and safety of patient care and on patients’ experience.”
Dr Patrick Cadigan, registrar of the Royal College of Physicians (RCP), added: “Emergency care systems must be redesigned to better deliver high quality care for patients in a time of need, whilst ensuring clinicians’ workloads and working practices are safe and sustainable. The planning and implementation of system redesign must be clinically-led.”
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