Patients attending accident and emergency departments in England and Wales are waiting longer than they did five years ago, both to be admitted to hospital and to see a doctor once they get there. This is despite an annual 1% increase in the numbers of patients using emergency departments, which has been more than matched by a 10% rise in the number of accident and emergency doctors since 1998.
The findings, from an Audit Commission survey carried out in England and Wales last July and published this week, paint a picture of poorly managed emergency departments in urgent need of “improvements to capa-city, efficiency and quality.”
Only about half of the departments surveyed could guarantee to have an experienced emergency doctor on call 24 hours a day, and only a third of patients needing thromboly-sis received it within 30 minutes of arriving at hospital.
The survey found that while some emergency departments could reasonably expect to meet the NHS Plan's target of a reduction in average waiting times to 75 minutes by 2004, most were well behind schedule.
“Although some departments are seeing more patients within one hour than in 1998, the majority see fewer,” stated the report. “In fact, waiting times have been increasing since first measured by the Audit Commission in 1996. The rate of deterioration has increased since 1998.”
The Audit Commission suggested in its report that improvements to the service could be achieved through more efficient management of staff workloads, with non-urgent cases being dealt with by nurse practitioners while senior house officers attend to the more serious cases. “Nurse practitioners could potentially reduce the work loads of doctors by allowing more patients to be treated and discharged without the need to see a doctor at all, yet only 1 in 20 departments have nurse practitioners who see more than 10% of the patients.”
The report also called for better availability of doctors with more than six months' experience of emergency work—only about half of departments had an experienced doctor available 24 hours a day.
One major barrier to improving the service offered by emergency departments was the inefficient handling of patient records. The survey found that 14% of emergency departments did not have a computer system at all.
Accident & Emergency. Acute Hospital Portfolio, Review of National Findings is available from: Audit Commission Publications, PO Box 99, Wetherby S23 7JA (freephone: 0800 502030) £10.00 net 