A&E crisis Flashcards
What are the different types of emergency departments?
- Type 1 departments are what most people think of as an A&E service: major emergency consultant-led departments providing a 24-hour service. These departments account for most attendances (63% in 2018/19).
- Type 2 departments are dedicated to specific specialities (e.g. treating only eye conditions or dental issues).
- Type 3 departments treat minor injuries and illnesses and include walk-in centres or minor injury units.
When did the NHS last meet the 4-hour standard?
The NHS has not met the four-hour standard at a national level in any year since 2013/14, and the standard has been missed in every month since July 2015 as of August 2020.
What is the 4-hour standard?
The current A&E standard was introduced in 2010. It states that 95% of people arriving at an A&E department should be admitted to hospital, transferred to a more appropriate care setting, or discharged home within four hours.
What are the trends in A&E attendance?
Before the coronavirus pandemic, an increasing number of people were attending A&E. On average in 2018-19, 67,991 people attended A&E each day in England; this was a 17% increase on the 2010-11 numbers.
What is exit blocking?
‘Exit block’ occurs when there is a delay in admitting patients to the ward from A&E due to a lack of beds. The problem of exit blocking leads to delays in diagnosis and treatment, which can in turn cause harm to patients.
What proportions of older people have long term conditions?
An ageing population is likely to also contribute to increased pressure on A&E, as three-quarters of 75-year olds have more than one long term condition, increasing to 82% of 85-year olds.
How do unnecessary attendees of A&E affect waiting times?
A lack of awareness abut where to seek treatment means many people attend A&E unnecessarily, causing increased waiting times.
How does the care and support shortage affect waiting times?
- Some people may need additional home support or a place in a nursing home. A patient who no longer has a medical condition requiring hospital treatment but who cannot be discharged from hospital is described as a delayed discharge or “bed blocking”, which in turn may cause a backlog to A&E due to bed shortages.
How do staffing shortages affect waiting times?
Staffing issues in A&E departments often lead to an increased workload for the remaining workers, a greater number of sick days and loss of workers due to transfers or resignations. The burnout rate gets progressively worse for the longest-serving staff, and the cycle can drag down the efficiency of whole departments.
What is one proposed solution to alleviate the burden on A&E departments?
By assembling GPs, A&E staff, urgent care teams and pharmacists to create new emergency and urgent care hubs. These hubs would serve much larger catchment areas, and could draw staff away from more rural surgeries which are often most used by the elderly, vulnerable and less mobile.
In February 2017, Peterborough and Cambridgeshire CCG ran a pilot of Local Urgent Care Services (LUCS) hubs at three hospitals. The aim was to improve access to urgent care by providing a “one-stop service” for patients suffering from minor injuries and illnesses, and to treat a broader range of patients locally. Nearly 13,500 people used the service in the first year, helping to reduce pressure on the local A&E departments.
