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Clinical indicators coming to A&E


The time patients wait for pain relief is one of the clinical indicators likely to replace the four hour accident and emergency target, Nursing Times has learnt.

Other measures, including overall patient satisfaction, timely delivery of antibiotics and the time to provide CT scans are also likely to be included on a “dashboard” of outcome measures being introduced to A&E units next year.

Meanwhile, the target for 98 per cent of A&E patients to wait for fewer than four hours will be relaxed to 95 per cent for the rest of 2010-11, to help nurses focus on clinical priorities.

The clinical indicators are being drawn up by the Department of Health’s national clinical director for urgent and emergency care Professor Matthew Cooke, alongside bodies such as the RCN, the College of Emergency Medicine and the Faculty of Emergency Nursing.

RCN acute and emergency care adviser Alan Dobson said the four hour target had succeeded dramatically in cutting waiting times but the relaxation to 95 per cent would allow nurses and other clinical staff to focus on clinical priorities.

He said: “Ninety eight per cent was excessive and one of the unintended consequences was that there was a lot of pressure on nurses, such as not to report breaches”.

The revised operating framework for 2010-11, published by the DH last week, says the indicators will be piloted this year “with a view to them being fully embedded from 2011-12”.

Faculty of Emergency Nursing president Phil Downing said he was a “little concerned” that the four hour target had been relaxed before the new clinical measurements had been put in place.

College of Emergency Medicine vice president Don MacKechnie said there was likely to be a time element remaining for some of the clinical indicators.

He said: “What we do not want to see is that once decisions are made to admit patients, they spend too long lying on a bed in the A&E department.

“The four hour target has achieved a lot and we don’t want to go back to the days of patients waiting hours and hours for treatment.”



Readers' comments (4)

  • I work in the middle east and we have been measuring performance through clinical indicators for many years now. The nurses are entirely responsible for deciding on the indicators wihtin their nursing area and displaying results gives all an incentive to perform to their highest standard.

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  • tich x

    i work an acutemedical ward and have no experience of A&E. however it seems to me the 4hr target was a good thing/ measure. so i ask... if it aint broken why try to fix it?

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  • tich x, I would suggest that the four hour target is not not broken (apologies for the double negative); the target has a negative impact on patient care and safety.

    When a patient is approcahing the 4 hour wait then the priority switches from treating the patient to ensuring that they do not breach the four hour target; thus patients may be transferred to a ward without sufficient analgesia on board or antibiotics not given. It also means that patients who are less unwell suddenly take priority over patients who have just arrived and are hence more unwell. This also has a knock on effect on receiving wards, because they are suddenly put under pressure to find beds at relatively short notice, and if the hospital is running at near capacity then this could prove impossible.

    A hospital that meets the 4 hour target receives a sum of money from the DH, whereas hospitals that don't meet the target receive nothing extra.

    By changing the auditing process to clinical markers, such as administration of ananlgesia or antibiotics within a specific time, as they do in the USA, from a more generalised fixed target patient care should improve. One size does not fit all. Although this may mean patients remaining in the ED for longer, hopefully by the time they are transferred to a ward they are in a better state of well being. What needs to be avoided is the boarding of 'stable' patients in the ED because there are no beds on receiving wards and no pressure to find them. This will need to be addressed.

    The problem as I see it is that there is no systematic approach to admitting and discharging people to/from the hospital as a whole. Potential admissions need to be identified when patients arrive in the ED, in many cases this could be done when they are first assessed by nurses, they could then be placed as provisionally requiring a bed and a provisional request made, it can always be cancelled later.

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  • tich x

    John, i totally agree with your various points but as the article say might have been a good idea though to have the new system/ markers in place 1st. you seem to have answered my other concern in your last paragraph. i hate it when patients are moved to an inappropriate ward to meet the targets/ make beds but how will this be balanced? my worry will be that there will be little pressure to keep discharges going.
    however John, how about the 18month wait / target? surely if i am a patient i cant afford any longer waits?

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