A statistical briefing from the Health and Social Care Information Centre (HSCIC) indicates that there has been a small – but significant – increase in the number of over-65s attending the major A&E units. The problem lies in the fact that these are the people who are likely to have complex multiple health problems and who are more time-intensive to assess and treat.
The proportion of overall attendances by the over-65s now accounts for 21% of the total; up from 19% four years ago. This shift is driven by the ageing population, and possibly by cuts in community health and social care budgets.
Performance is measured by the proportion of patients who wait longer than four hours before being seen. In 2008-9, the proportion over this target was just under 3%, but last year it had risen to over 6% for major A&E units. There is a noticeable “spike” in admissions as the target deadline approaches.
Triggle, N. (2013). A&E: The straw that broke the camel’s back. London: BBC Health News, December 3rd 2013.
This relates to:
Focus on Accident & Emergency: December 2013. London: Health and Social Care Information Centre, December 3rd 2013.
Triggle, N. (2013). A&E units miss four-hour target. London: BBC Health News, December 13th 2013.
There are some concerns that – while performance monitoring is indeed important – an obsessional “target culture” in the NHS can itself be dysfunctional and impede genuine quality improvement:
Jeremy Hunt crazy to call hospital bosses, says regulator. London: BBC Health News, December 21st 2013.
Also of possible interest:
Urgent and Emergency Care Review reports and outcomes. London: NHS Choices, November 13th 2013.
Emergency Readmissions to Hospital Within 28 Days of Discharge
Health and Social Care Information Centre (HSCIC) figures indicate that emergency readmission rates for persons in England are highest for patients admitted for fractured proximal femur (12.6%) followed by stroke (11.7%). Other measures cover: all emergency readmissions (11.5%), hysterectomy (7.3%), and primary hip replacement (5.3%).
Hospital Episode Statistics, Emergency Readmissions to Hospital Within 28 Days of Discharge – Financial year 2011-12. London: Health and Social Care Information Centre, December 5th 2013.
Accident and Emergency Quality Indicators (England, By Provider): September 2013
HSCIC A&E data based on hospital episode statistics (HES) A&E data represents quality and performance information for the following A&E indicators:
- Left department before being seen for treatment rate.
- Re-attendance rate.
- Time to initial assessment.
- Time to treatment.
- Total time in A&E.
“The median average total time in A&E for all patients was 2 hours 9 minutes, with 95 per cent of patients departing A&E within 4 hours 32 minutes of arrival”.
Read more Health & Social Care Information Centre.
Provisional Accident and Emergency Quality Indicators, England – By provider for September 2013. London: Health and Social Care Information Centre, December 20th 2013.
Delayed Handovers Between Ambulance and A&E Staff
Freedom of information (FOI) figures on ambulance queuing and delays at A&E:
Jeffreys, B. (2013). Ambulances ‘face long delays at A&E’ – BBC figures reveal. London: BBC Health News, December 9th 2013.
Triggle, N. (2013). Ambulances ‘face long delays at A&E’ – BBC figures reveal. London: BBC Health News, December 9th 2013.
More recent statistics:
Mundasad, S. (2014). Patients ‘face long queues in ambulances outside A&E’. London: BBC Health News, August 10th 2014.
GP Consensus in Potential of Primary Care Alternatives to Emergency Hospital Admissions (BMJ Open)
A survey of GPs’ agreement, on the appropriateness of patients for management in primary care as an alternative to Emergency Department patient admissions, indicates that a significant number of patients attending Emergency Departments could be managed by GPs, including those requiring investigations at triage. The authors propose effective signposting for patients presenting with acute or urgent problems and support for a more proactive role of primary care as potential solutions to the problem of relieving the severe pressures on emergency hospital admissions in the UK
Thompson, MI. Lasserson, D. McCann, L. [et al] (2013). Suitability of emergency department attenders to be assessed in primary care: survey of general practitioner agreement in a random sample of triage records analysed in a service evaluation project. BMJ Open, December 6th 2013, Vol.3(12), pp.e003612. (Click here to view the PubMed abstract).
Funding for GP Out-of-Hours in England Fallen?
Full Text Link (Note: This article may require a suitable Athens password, a journal subscription or payment for access).
Iacobucci, G. (2014). Funding for GP out of hours in England has fallen by £65m since 2012. BMJ (Clinical research ed.), April 30th 2014, Vol. 348, g3032.
Systematic Review of Primary Care Service Interventions for Reducing Inappropriate Accident and Emergency Department Attendances (British Journal of General Practice)
Evidence suggests that emergency nurse practitioners in community settings and community health centres may reduce Accident and Emergency Department attendances. Other interventions, including walk-in centres, minor injuries units, and out-of-hours general practice appear to have less-marked impacts in terms of A&E attendance, patient outcomes and cost-reductions.
Ismail, SA. Gibbons, DC. [and] Gnani, S. (2013). Reducing inappropriate accident and emergency department attendances: a systematic review of primary care service interventions. British Journal of General Practice: the Journal of the Royal College of General Practitioners, December 2013, Vol.63(617), pp.813-20. (Click here to view the PubMed abstract).
College of Emergency Medicine Recommendations
In May 2013 the College of Emergency Medicine (CEM) issued guidelines on how to achieve safe, sustainable care in Emergency Departments:
Triggle, N. (2014). A&E must change or face collapse, NHS warned. London: BBC Health News, May 15th 2013.
This relates to:
The drive for quality: how to achieve safe, sustainable care in our Emergency Departments? System benchmarks & recommendations. London: The College of Emergency Medicine. May 2013.