THE President of the Royal College of Emergency Medicine, Dr Katherine Henderson, has urged hospital boards to ‘take immediate action’ to reduce crowding in Emergency Departments this winter.
‘The RCEM is extremely concerned about what we are hearing from our Members and Fellows about crowded Emergency Departments throughout the UK,’ Dr Henderson emphasised.
‘As the declaration of a critical incident at Nottingham University Hospitals Trust shows, winter has clearly arrived after minimal let-up over the summer.
‘Most departments are struggling to admit patients into hospital beds, and offload ambulances. The result is that sick and elderly and frail people are spending hours waiting on trolleys in a noisy, undignified environment.
‘We are calling on hospital Boards to take action. There must be a focus on creating capacity within the hospital to get sick patients out of the Emergency Department once they are ready to be admitted; long waits in emergency departments are associated with increased mortality.’
And in this week’s joint statement by RCEM and SAM (Society of Acute Medicine) regarding Same Day Emergency Care (SDEC), the two organisations have agreed: ‘There has been much publicity recently around provision of Same Day Emergency Care services as outlined in the NHS Long Term Plan 2019.
‘RCEM and SAM endorse the provision of these services and we are aware that there is a lot of anxiety from both AM (Acute Medicine) and EM clinicians regarding the pace of change.
They include a warning about potential misuse of SDEC:
- SDEC is not an alternative facility to be used to maintain performance against any time-based target.
- SDEC is not a space for patients who present to the Emergency Department who would not have been considered for admission to be managed i.e. ‘minors’ type patients. SDEC is not an alternative to an inpatient bed if that is what the patient needs even at times of system stress, and is not a ‘place to wait’ for that bed.
- SDEC is about a skilled team of health care professionals delivering high quality care to a cohort of patients in a safe environment that meets their needs, on the same day without admittance. The multi-disciplinary model of SDEC delivery provides a rich environment for training of future clinicians, working in may disciplines who will be delivering acute care.
The RCEM and SAM continue with their overall endorsement of the plan:
‘In reality nearly all acute trusts in the country already deliver some form of same day emergency care, and NHSE research suggests that 89% of acute providers have a designated unit where most of the SDEC occurs.
‘SDEC services are run by a disparate group of clinicians, but the largest cohort of patients are seen by clinicians with a background in Acute or Emergency Medicine. These groups of professionals share this similar patient cohort in relation to those patients who present with SDEC sensitive conditions either to the Emergency Department, acute medical take or SDEC unit.
‘We also recognise that paediatricians have increasingly moved to an SDEC model of care and more recently many sites have developed surgical and orthopaedic SDEC pathways and SDEC services for frail patients …
‘We encourage those working in acute care to work together to develop their SDEC services, using local expertise, workforce and organisational structure, and this approach is explicitly supported by the NHS.
‘The benefits of effective SDEC delivery to teams working to deliver acute care “at the front door” include; reducing unwarranted variation in care pathways, streamlining the patient journey, better patient and staff satisfaction, reduction of admissions and improvement of flow in the acute admission pathway.
‘Same day emergency care is synonymous with ambulatory emergency care (AEC). It is the care process whereby a patient who has been referred or self-presented to secondary care in an emergency is assessed, investigated and treated without being admitted to a traditional inpatient bed.
‘This process can occur in several settings including an area of an Emergency Department or a specific SDEC (AEC) unit typically, but not exclusively, under the auspices of the Acute Medical team. This care would usually be delivered in a 4hr-12 hr time frame and may be spread out over more than one day if a pathway indicates this.
‘However, the hallmark remains that the patient sleeps in their own bed and not an in-patient hospital one.
- The ambitions included in the NHS 2019 Long Term Plan are to implement SDEC seven days a week, 12 hours a day in every hospital with a ‘type 1’ (consultant-led 24 hour) ED and in addition to provide 70hrs of a defined frailty service a week.
- SDEC should facilitate the right people to be treated in the right place at the right time for that person’s condition and is intended to bring about a positive experience and achieve the best outcomes for that patient
- In the future the ECDS (Emergency Care Data Set) will be rolled out across SDEC to make it easier to get high quality data and appropriate remuneration for the work done.’
The two organisations hope that the preceding explanation dispels some ‘rumours, myths and concerns around SDEC delivery’.
At the same time, doctors’ union the British Medical Association (BMA) has urged in its just-published Manifesto for Health that it is necessary ‘to put the NHS back on a sustainable footing and an end to the punitive pension tax system which is driving doctors out of the workforce, in a manifesto to the political parties contesting the upcoming general election.
‘There is growing evidence of the effect of the pensions crisis from a host of surveys carried out by medical royal colleges and other medical groups in the past week. The manifesto … urges fair pay for doctors which truly values the medical workforce and helps to retain staff.
‘The need for urgent action comes as new analysis from the BMA shows more than one million patients could experience waits of more than four hours at emergency departments this winter and almost a third of a million will wait on trolleys to be treated.’
- The NHS in Scotland will need at least 320 extra beds to prevent thousands of patients being treated in corridors this winter.
Analysis by RCEM Scotland of Acute Hospital Activity and NHS Beds Information in Scotland suggests that in order to keep bed occupancy at a safe level and keep emergency departments moving, approximately 320 staffed beds will be needed.
The Vice President of RCEM Scotland, Dr David Chung said: ‘Since 2009/10 NHS Scotland has lost over 1,000 staffed beds across all acute specialities, despite increases in Emergency Department admissions.
‘Based on the provisional figures released for 2018/2019, NHS Scotland needs at least 320 beds restored to avoid trolley waits this Winter. Increased provision in the Community and Primary Care could reduce the requirement for hospital beds, and RCEM Scottish Board would urge that such capacity is also provided at a level to meet the demand required.
‘Whilst the announcement of £10 million to support winter pressures is a positive step, temporary funding injected into the system at this point of the year will make it difficult for Emergency Departments to respond to winter pressures.
‘Planning for winter should be considered and funded earlier in the year. This summer was challenging enough as we saw more and more people waiting on trolleys for long periods of time.
‘Data released today shows that only 87.6% of patients were seen within the four-hour target in September 2019 and the number of patients waiting twelve hours or more has increased by 59.4% since September 2018.
‘We clearly do not have enough capacity to meet the increased demand and we risk compromising patient safety if this is not urgently addressed.’