The most demanding part of the year is approaching – we can already feel the beginnings of winter pressures.
The volume of patients coming through the front door reaches new levels each year. Do they all need to be in accident and emergency (A&E)? No, but we’ll get onto that.
Overcrowding in A&E is a national crisis; it impedes the department’s functionality and safety. There is extensive evidence that when departments are at high capacity – 90% and above – adverse patient outcomes increase significantly, including mortality.
With high attendance levels compromising safety, patient flow becomes the rescuing factor.
“The back door of the hospital can be just as promblematic as the front”
Getting patients out of the department – whether it is through discharges, admitting them to wards, or referrals to walk-in centre or GPs – helps restore the ability to offer safe, high-quality care.
Much of the congestion derives from the department filling up with patients who need to be admitted – but having no base ward to go to. The back door of the hospital can be just as problematic as the front in this situation.
Hospital wards fill up with medically fit patients awaiting spaces in nursing homes or care packages to commence in the community. With a growing, ageing population and tighter financial constraints on local authorities – the ‘bed blocking’ is only going to worsen.
Another issue is the misuse of A&E departments – patients presenting with problems that can be solved elsewhere. By coming into the department with minor ailments you escalate the waiting time, delaying legitimately unwell attenders.
The NHS estimates between two and three million people who come to A&E each year could have their needs addressed in other parts of the urgent care system. Some examples of inappropriate reasons for attending A&E include: dandruff, needing emergency contraception, being unable to sleep, months history of back pain and the common cold.
“There still seems to be an ongoing widespread lack of awareness of other options”
Pharmacies, GPs, walk-in centres and self-treatments from supermarkets can solve all of these issues. A&E departments do not need the extra strain.
Despite numerous public campaigns, there still seems to be an ongoing widespread lack of awareness of other options, A&E is just the easy option. Blaming patients for going to the ‘wrong place’ when they need care and support is the wrong way of looking at the problem.
Not only do the general public need a further education on which services are available but there need to be more options available out of hours. In essence, the whole health and social care services need financial investment – despite this certainty everyone is more cash-strapped than ever.
Ben Mullin is charge nurse, Royal Liverpool A&E