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Hospitals moving patients to hit four-hour A&E targets


Hospitals are routinely moving large number of patients from their A&E departments in the last few minutes of the four-hour target time for treatment in emergency departments, Freedom of Information figures have revealed.

More than 20% of patients left the A&E department where they were being treated in the last 20 minutes of the target time at five hospitals, and more than 15% of patients were moved out of A&E at the last minute in 20 hospitals.

The figures, revealed through FoI requests from the Liberal Democrats, show that 16 hospitals had a higher spike in last minute A&E discharge activity than Mid Staffordshire Hospital.

The hospital was heavily criticised in a recent high profile report by the Healthcare Commission – now part of the Care Quality Commission – for focusing on the four-hour A&E treatment target at the expense of patient care.

Liberal Democrat shadow health secretary Norman Lamb said: ‘Patient safety should be top priority for the NHS, not hitting targets.’


Should the four-hour target be scrapped?

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Readers' comments (14)

  • This story will not come as a surprise to anyone who works in A+E or who has "waited" a long time for treatment.
    Those coming up to the target time are often moved, sometimes to a bed space not far from the original, in order to comply with target times.
    It is right that patient care should take priority over targets, but until they are abolished hospital staff have no choice but to try to meet them.

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  • i haven't worked in A+E since 2007 but this happened all the time when i worked there and the times i've done bank shifts since then it still happens.
    i nursed in A+E before the targets and yes, the wait was awful but now as a nurse it feels like your just doing the bare minimum, kind of keeping your head above water so to speak and i often transfer patients feeling i haven't done a good enough job...
    but hey, at least patients are only in A+E for 4 hrs?!?

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  • I totally and wholly agree with the previous 2 posts. As an A&E sister for almost 10 years, I too have seen the change in culture from 'care to clock watch.' Whilst I admit that the culture had to change from the 3 days on a trolley situation I feel we have now gone too far the other way. As for improving patient care how can this be achieved when staff are pushed to the extremes. Not only clinically due to working within a fast paced stressful area, but whom are now burdened with delivering adequate care within a sometimes impossible target. Not only this but we are constantly harrassed by managers, and service co-ordinators and pen pushers to meet the targets and then verbally berate us when the targets are not met and hold individual staff personally accountable for the breaches. The governement needs to open their eyes and find the medium ground between improving the waiting times and the patient's journey and not undermining any efforts of staff recruitment and retention. This or at very least give us the staff, resources and funding to enable us to even have half a chance to meet their targets!

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  • I work in A & E and part of more work is the breach information, It is very interesting to watch how many patients are discharged/admitted at 3.59 minutes!. Figurers are manipulated to show patients are moved within 4 hours -yes the computer says 3.59 but patients are still on the trolleys. I know we aren't the only hospital to do this, we have read in the nursing press in the past. All this to show the government hosptals can cope, but guess what we can't! Scrap the 4 hour target and give nurses a chance to do the real job they are employed to do NURSE.

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  • I agree with the comments/opinions of the A & E sister.
    I am a matron & one of the areas I am responsible for is Neurosurgery with insufficient beds- a regional unit - many of the patients are critically ill or with multiple care factors - I, to have to answer to the 'managers' when I have a A & E breach. While I do not support hours & hours on a trolley, it is ludicrous that patients are sent from A & E before they have being properly assessed and investigations started/completed just to meet 4 hr tartget.
    3hr 50+ is the norm!!! Getting the appropriate care is what it should be about not clock watching.

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  • I work in Medical Admissions and feel the brunt of the 4 hour target in A+E when patients are moved in a panic to avoid the breach. However, I really do agree with the principle of the 4 hour target. What I don't agree with is the way in which trusts have not put measures in place to deal with the target and therefore patients moved inappropriately, and also remain on trolleys in other areas of the hospitals. I feel that the whole purpose of the target was to avoid having frail, elderly patients on trolleys for days on end waiting for a bed to come up - but this is still happening but being hidden by the trusts by manipulation of figures. Government can only work with data given to them by the trusts, data which has been massaged by trusts to hide the real situation.

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  • I was going to add "no, REALLY?" - but everyone else contributing has, to quote Take That, 'said it all'.
    What would happen if production-line values such as target times were dropped? After all, we're dealing with living, diverse, individuals, not internal combustion engines! Then, perhaps, those contributors and their colleagues would be able to 'nurse' as was their aspiration in joining the profession....

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  • I have been part of A&E for many years as a nurse,a manager, an ENP, and a Nurse Consultant and I have worked in many units across the UK and overseas. I agree it has all been said by the other comments, 4 hours is a perfectly long enough time for most patients to be in A&E. Hospital teams have made significant changes in thinking and in practice to support this. However as usual staff are put under pressure without resource/technology to meet this undeliverable expectation. Patients are pulled into a system of admission and the lack of capacity in beds has turned most hospitals in sausage factories. The overall message from the DOH in terms of waiting times planned and emergency, and increasing public expectation on the NHS is unrealistic and we are not resourced to give a quality service in a framework of deadlines.

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  • I work on a surgical admissions ward, and we are frequently pressured by A & E to accept patients from there as they are about to breach, then when they arrive onto the ward, they are still waiting to see if the surgeon will accept them, if they are not a surgical problem we are then stuck with a patient no-one will account for.

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  • I work in A&E and regularly look after patients who have been in over 4 hours - doing obs, giving meds etc which I sign for using the time and date correctly - However when a bed on the ward turns up for example half an hour past breach time the management will put down the time leaving A&E as much earlier just to stop it showing as a 4 hour breach. Yet if anything serious ever happened and the coroner got involved and noticed the discrepancy between "leaving" A&E and yet treatment still being given and signed for in A&E after supposedly having 'left' A&E then stuff would hit the fan big style! In essence management are falsifying medical records and this is an offence that will get them struck off by The NMC. I'm not willing to lose my whole career just to make this Governments targets look good ( especially whilst they swan around leeching from the taxpayer with their extravagent expense account lifestyles) Grrr it makes me angry!

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