Financial pressure and a lack of nurses is leading to increasing overcrowding in accident and emergency departments, it has been claimed.
The warnings come in response to a Nursing Times investigation, which found the number of patients waiting up to 12 hours for a bed has rocketed by nearly a third in the space of a year.
During the first six months of 2012 66,845 patients waited between four hours and 12 hours for a bed once a decision had been taken to admit them, analysis of Department of Health data revealed. This is up from 50,944 in the same period the previous year – a 31% rise.
Nursing Times’ findings support the results of a survey by the Royal College of Nursing earlier this year, in which half of A&E nurses reported that patients were receiving care in corridors or other inappropriate areas at least once a day.
Tim Curry, RCN assistant head of UK nursing, blamed the increase on a “perfect storm” of rising patient expectations, financial pressure in the acute sector, and distractions caused by restructuring and reform in the primary care and community sector.
He said while it could sometime be appropriate for patients to be managed in A&E – for example, if they were waiting for diagnostic tests – the scale of the increase was “startling”.
“You need skilled nurses and vacant beds, and both of those are under huge pressure. Making contact with district nursing teams is also harder at the moment,” he said.
Mr Curry called for more trusts to give nurses the authority to discharge patients in order to improve patient flow.
The main A&E performance measure currently used by the DH and Monitor, the foundation trust regulator, requires trusts to admit or discharge 95% of A&E patients within four hours.
Nursing Times assessed trusts using the old “trolley wait” target used by the government in the early 2000s. Trusts were judged to have failed if 5% or more of all emergency admissions waited more than four hours for a bed.
Using this measure, 27 of the 146 trusts analysed were found to have under-achieved during the first six months of 2012, up from 14 in the same period in 2011. A change in how the DH publishes A&E performance data halfway through 2011-12 prevents full year-on-year comparison.
College of Emergency Medicine president Mike Clancy told Nursing Times the rise in patients waiting longer to be admitted was a reflection of the pressure on hospital bed stock.
“It’s a high pressure system and small changes in demand make a big change in waiting. We are asking wards to handle more patients faster,” he said.
“There is quite clear evidence that with overcrowding goes increased mortality and morbidity. There is a real patient safety issue.”
Mr Clancy said there was anecdotal evidence that A&E attendances were increasing during periods that were harder to staff, for example evenings and weekends. He said this was being exacerbated by difficulty in recruiting to emergency departments.
A spokeswoman for Wye Valley Trust, which the investigation found had a high proportion of patients waiting more than four hours for a bed, said its figures had been affected by the introduction of a clinical decisions unit.
This had increased the number of patients managed in A&E without going onto a ward while also reducing overall length of stay for some conditions.
Matthew Cooke, the DH’s national clinical director for urgent and emergency care, told Nursing Times this kind of change in practice was likely to be driving the trend, along with the changing patterns of demand, such as more patients presenting in the evenings and at weekends.
“We have to keep working to make sure our staffing levels match the demand,” he said.
A spokeswoman for Surrey and Sussex Healthcare, which was found to have the highest proportion of patients waiting for four hours or more over the period, said performance had recently improved.
She said the trust was refurbishing its A&E to increase capacity, had added 40 beds in new wards and recruited more consultants. This had already led to an improvement, with 99.4% of patients seen within four hours in the week ending 20 May.
Meanwhile, a change in patterns of demand was one of the factors behind a doubling in the number of patients waiting more than four hours for a bed at Northampton General Hospital.
Its chief operating officer Christine Allen said the trust had completed a refurbishment of its emergency department to increase capacity in May, recruited more staff and matched staffing to the times of day with most demand.
She said: “We have done all we can in terms of creating capacity, but what we now need to do is work with our commissioners to improve the urgent care pathway from primary care right through to discharge from hospital.”