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A&E targets 'compromising safety'


Accident and Emergency waiting time targets are endangering patient safety and care, a leading group of doctors has warned.

The College of Emergency Medicine (CEM) claimed the four-hour target was putting NHS staff under “incredible pressure”, saying that circumstances meant it could not always be met.

While supporting the scheme in principle, the CEM said quality should always take priority over waiting times, especially when lives were at stake. On average four to five consultants are assigned to accident and emergency units which receive between 60,000 and 80,000 patients a year - a “woefully inadequate” ratio, he said.

CEM chairman Dr John Heyworth claimed the desire to meet the mark at any cost was dangerous and had gone too far.

He said: “We’ve had nurses reduced to tears. We’ve had very senior consultants in emergency medicine threatened with a disciplinary process. This is an outrageous misuse of the standard.

“It’s not what the clinicians are in the emergency departments for. But it’s representative of the immense pressure being put on chief executives and all managers downwards from there to comply with the target.”

Responding, a Department of Health spokesman said: “Patient safety and good quality care should always take priority over administrative targets where a doctor believes that is necessary. Ministers have repeatedly said that to managers and doctors.”

Figures released by the Department of Health have shown that at the beginning of 2003 almost a quarter of patients spent more than four hours in A&E.

Department of Health statistics for 2008/09 have shown 98.1% of patients in England spent less than four hours in A&E from arrival to admission, transfer or discharge.


Readers' comments (10)

  • The spokesman for the DoH really needs to go and spend some time in a busy understaffed A&E department. Dr's end up working longer than they need to just so they can catch up on administrative tasks. What the DoH and the government have to realise is that communities and are growing, A&E departments are having to cope with the extra numbers coming through the doors. People are coming in who are very sick. I have spent many a shift working 12 hours with no break. I have witnesses managers manipulate waiting times so they look good - patient care cannot be given 100% unless A&E departments are given more experiences nurses and dr's, maybe then there will be no more breaches and there will be 100% patient care...............

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  • This has been said over and over and over for years now, but the idiots in charge will never listen because they want to create nice little soundbites or kudos for politicians, none of these decisions have been made with clinical CARE in mind.

    And anonymous above, I know exactly what you mean, I think anyone who has worked on A&E, Nurse or Doctor has done those 12 hour shifts and seen those exact things. It is time the decision making was made by the professionals (ie Doctors and Nurses), not idiot politicians or patient groups!

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  • Clinical staff have been unable to manage A&E departments for decades prior to the setting of the 4 hour target - decision making your having a laugh, people on trolleys for 2 days? Yes, remember what it was like before? The issue isn't the 4 hour target but having more than adequate resources and high quality staff to administer it.

    AND I've also worked in A&E departments who fiddle their figures - guess what, the requests for more staff are turned down because it looks like they are coping.

    Find me a consultant or nurse manger with some backbone and I bet you they are not whining about 'very senior consultants threatened with discipline'.

    I'll call you a WAAAAAAHMBULANCE.

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  • HA! tell me something I don't know! I work in a busy A&E dept. and I have bed managers calling me, screaming that there will be no breaches today, do I make myself clear? Asking us to roll back the times on the system, remove patients from the screen whilst they are still with us! I see patients being rushed to wards before they breach and have not been seen by a doctor or nurse. The wards are then overfull with no plan of care for these sick patients. I could go on and on but i am sure you have all been there. It's a joke, my colleagues and I crying under the pressure, mistakes being made etc etc
    This government are a joke and the public need to know that the figures ARE ALL LIES! Give us more staff to cope and then this horrible system could cease to exist!

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  • I totally agree that the four hour target compromise patient care. Patient being transferred to the wards very unstable,initial treatment not given in AE because they are in a hurry to transfer the patient to the wards, worse comes to worse, patient's name already transferred in the ward's computer system,but patient is still in AE department, this is just to reflect in the system that the patient hasn't breach (total dishonesty, it's a shame!). I think, it is reasonable to hire more competent doctors and nurses who will be able to care for the increasing number of patients coming to AE,which hopefully will ensure compliance with the four hour target and also will ensure quality patient care.

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  • I completely agree with all the above statements 100%. I have worked in a busy A&E department where "Breechers" were the only thing on the senior nurses and consultants minds. Patients were treated as a number, rushed in and out of the department with no sight of basic care. It was shocking, and is only getting worse. Elderly patients who have never been in hospital, no even being provided with as much as a smile! The department moral was very low! Nursing staff not being able to carry out their job due to increased pressure from above. Seriously ill patients being transfered from the department before they should have been! Its about time something was done about this! Yes targets should be met where possible, but there are exceptions to this. I have seen nurses fiddle with patients times to make sure they hav not "breeched". This pressure on staff is not allowing us to carry out the job we have been trained to do!

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  • The four hour waiting list is enforced at the peril of patient care. I am all to familiar with the comments detailed by the previous members of the NHS.

    I work in a very busy acute surgical admissions unit and thus accept patients from GPs but A&E also. The four hour waiting list undoubtably forces the hand of staff to make clinical decisions that are in fact detrimental to patient care often. I agree that more experienced staff may need to be allocated to A&E departments to turn this around, however, I truely believe that the pressure enforced on those working in A&E to avoid breaches is compounded by the four hour waiting times.

    I have been on the receiving hand of this whereby patients thought to have a leaking AAA have been transfered without appropriate care. This is true in the most basic form. Patients are repeatedly transfered in "agony", with no IV access, thus no IVI. Amny occassions without bloods or even a plan of care.

    One case that comes to mind on many occassions is the time that the sister in A&E communicated with myself regarding a lady about to breach. This was a late referral which was made only 10minutes prior to breaching time. I had then following our call liaised with the consultant who happened to be in theatre, of whom said that the lady was unlikely to be surgical and thus under no circumstance should she be accepted to SAU until her bloods had been reviewed. That in mind I spoke with the sister who stated "tough she is on her way, deal with it!" No sooner had this lady arrived, in agony, we reviewed her bloods which indicated she was having an acute MI.

    This instance is not isolated. This is a patients life we are talking about, and for the sake of a four hour waiting list, it is of my opinion that everybody seems to have their proirities all wrong. How they get "away with it" bemuses me. It really does.

    If you cant even have a conscience to treat patients with respect and dignity, do not do this job.

    Once more, it is ok the DoH saying “Patient safety and good quality care should always take priority over administrative targets where a doctor believes that is necessary" seeks to only put them out of the frame for blame. It is turnt back around on the NHS staff, absolving themselves from any responsibility to ensure all targets are enforced. I feel very strongly on this matter and yet fear will it ever change for the better?

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  • Why does it take something like this for people to actually listen to the clinical staff? Any experienced A&E nurse has been saying this for years. Yes, I think some targets are good, they measure how the service is doing, but what is the point in having a target where the result is fudged and/or patient care compromised just for the numbers to be right. Every A&E nurse has their horror stories about the 4 hour breaches and yes, I also work in a department where we are told to fudge numbers and send patients to inappropriate places. Finally can someone do somthing about it?!

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  • I agree with everything that is said above. Nobody whos not worked on the shop floor cares yet when its their relative thats acutely ill they dont want them placed in the corridor do they?
    Then because they work for the nhs & are high up they get preferential treatment its disgusting. Nurses who genuinely care dont have the tme to care because the clocks against them stuff ghets missed & patients lives are compromised.
    How many more deaths will it take before someone calls it a day?

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  • four hour waiting times don't take into consideration the huge influx of patients we see arriving in A&E at the end of a popular TV programme or after the football has ended - the numbers are just too much for the department to handle! (Obviously these patients are not so sick if they were able to carefully time their departure from home so carefully - but we frequently seem to be a GP service not ACCIDENT or EMERGENCY!!!

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