accident and emergency – Page 2 – The NEN

Tip of the Iceberg: New report exposes real number of A&E waits

Over 1,000 patients faced a 12-hour wait in A&E every day in 2021

A new report by The Royal College of Emergency Medicine ‘Tip of the Iceberg: 12-Hour Stays in the Emergency Department’ reveals that on average 1,047 patients waited 12-hours or more from their time of arrival every day in a major Emergency Department in 2021 in England, equalling a total of 381,991 patients experiencing these 12-hour waits in 2021.

There is a total of 124 NHS Trusts in England. The College received responses from 74 NHS Trusts that were contacted. The figures above are only representative of 60% of NHS Trusts in England. The true total figure of 12-hour waits from time of arrival in major Emergency Departments in England in 2021 will be even higher.

These figures show the deep crisis facing the NHS and the Urgent and Emergency Care system. The alarming number of 12-hour waits are an indicator of the serious and dangerous levels of crowding occurring in Emergency Departments.

Crowding is unsafe, inhumane, and undignified for patients, our previous report Crowding and its Consequencesfound that patients can come to associated harm and even death.

The NHS in England currently measures 12-hour waits from decision to admit (DTA). The Decision to Admit is the decision to admit a patient to a hospital bed made by a clinician. Measuring from decision to admit is a gross underrepresentation of the reality of patient waits, as many patients will have already waited for a long period in a busy Emergency Department before this decision is made.

12-hour DTA waits have been increasing substantially, so much so that in the first four months of 2022 alone (January – April 2022) there were a total of 79,610 12-hour DTA waits; nearly as many as the cumulative total of the 11 years since data collection began (82,746 12-hour DTA waits between August 2010 – December 2021). It is evident that while the pandemic has contributed to the current situation somewhat, long waiting times have clearly been rising for over a decade.

Our recent report Beds in the NHS found that 25,000 staffed beds have been lost since 2010/11 and this has contributed to the steady increase in long waiting times in Emergency Departments since 2010/11 as detailed in Tip of the Iceberg.

Commenting on the FOI findings, Dr Adrian Boyle, Vice President of The Royal College of Emergency Medicine, said: “These figures are staggering and show the critical state of the Urgent and Emergency Care system.

“They also make clear that measuring 12-hour waits from decision to admit masks the reality facing patients and staff. Clearly, it is misleading to measure 12-hour waits in this way, and it is detrimental to staff efforts to improve A&E waiting times.

“NHS England have previously promised to make 12-hour data measured from time of arrival in the Emergency Department public and publish it alongside monthly NHS performance figures. We are still waiting for them to fulfil their promise.

“We recently wrote to Amanda Pritchard, Chief Executive of NHS England, about this, questioning why the data has not yet been published and when it will be. We have not received a response. Until it is published the NHS cannot hope to drive meaningful change and improvement in Emergency Care. Publishing this data will bring about greater accountability, and help all stakeholders understand the extent of crowding, long stays, and corridor care.

“NHS England must publish 12-hour data from time of arrival as a matter of urgency, this is the first step towards meaningfully tackling this crisis. At present, we fear that the full scale of this crisis is either being ignored or inadvertently misunderstood by the government.

“To truly tackle the problem, you must understand the scale of the task at hand. This data should facilitate better understanding of the challenges facing Urgent and Emergency Care and the wider health system and allow us to take the steps towards tackling it.

“In the short-term, the government must set out a meaningful plan for social care that includes recruitment and investment in the social care workforce and paying a wage that values and reflects significance of their role.

“In the medium-term, the government must finally commit to publishing a fully funded long-term workforce plan that recruits new staff into the health service and includes measures to retain existing staff who are burned out and questioning their careers. Then will it be possible to open the 13,000 staffed beds required to drive meaningful improvement within the health service.

“The health service is failing, and failure to act will take it deeper into crisis and inevitably lead to another ‘worst winter on record’ and further patient harm. The government can talk about phantom new hospitals all it likes, but political unwillingness to tackle the deepest health crisis in NHS history costs; the cost is both deteriorating patient health and patient lives, and an undervalued workforce struggling to deliver.”

Tip-of-the-Iceberg-12-Hour-Stays-in-the-Emergency-Department Download

Emergency Care ‘remains in extreme crisis’

More than one third of patients facing long waits in Scotland, as Emergency Care remains in severe crisis.

Responding to the latest weekly Emergency Department performance figures in Scotland Dr John Thomson, Vice President of The Royal College of Emergency Medicine Scotland, said: “We are continuing to see severely poor performance in the Emergency Care system. Staff are becoming more and more burnt out; the appalling crisis in Emergency Care is seriously distressing.

“The public are extremely worried about these long waiting times, and rightly so, because patients are coming to harm. Staff continue doing all they can to deliver care and keep patients safe, but it is incredibly challenging.

“It is a desperate situation, a result of widespread shortages of staff and beds throughout the system and a crisis in social care. Despite exiting winter and entering spring, the situation remains dire; we have never faced a crisis worse than this. The intense workload is breaking staff, and the distressing circumstances are breaking their morale.

“Patients continue to face seriously long waits, and we continue to state that this crisis is worse than ever, and that patients are coming to harm. The government cannot let this deteriorate further, staff and patients urgently need meaningful action now to tackle the desperate situation in Emergency Care and address the widespread staff shortages, the bed shortages, and the social care crisis.”

The latest weekly Emergency Department performance figures for Scotland show:

There were 22,774 attendances at Emergency Departments

Four-hour performance was 66.2%, the lowest ever on record-

7,705 patients waited more than four-hours in an Emergency Department

More than 3 in ten patients were waiting for more than four hours in an Emergency Department

2,373 patients waited more than eight-hours in an Emergency Department

Nearly one in six patients were waiting for more than eight-hours in an Emergency Department

944 patients waited more than 12-hours in an Emergency Department

One in twenty-five patients were waiting more than 12-hours in an Emergency Department

Royal College: Urgent and Emergency Care ‘in dire crisis’

RCEM urges action to address failing A & E system

The latest monthly Emergency Department (Major EDs) performance figures for Scotland for February 2022 show:

There were 95,692 attendances
Four-hour performance was 71.7%, 1.9% lower than the previous month, January 2022, and the second lowest on record
27,087 patients were delayed by four hours or more, this is means more than one in four patients were delayed by four hours or more
6,248 patients were delayed by eight hours or more
2,230 patients were delayed by 12 hours or more, this represents the highest proportion of attendances experiencing 12 hour waits since records began

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The crisis in Urgent and Emergency Care is dire. The health system in Scotland is ceasing to function as it should. Patients are at risk of severe harm and staff are facing stress, distress, burnout and moral injury on a daily basis.

“This is unsustainable and dangerous. The first step to tackling this crisis is opening 1,000 beds that are desperately needed across the system and recruiting senior decision makers in Emergency Medicine. In addition, the crisis in social care, which is resulting in the most vulnerable patients residing in hospital for extremely long periods of time before being discharged means that the system is unable to cope.

“This patient safety crisis must be a priority for the Scottish Government, and they must take meaningful action now before more patients come to severe harm.”

One in four ambulances delayed 30 minutes or more as Emergency Care falls deeper into crisis

The latest Winter Sitrep data for the week ending 27 March show:

There were 79,588 ambulance arrivals, 2.7% less than the previous week.
More than one quarter of ambulances experienced delays of 30 minutes or more, equal to 21,051 ambulances – an increase of 7.4% on the previous week
This is the highest proportion of ambulance delays on record
More than one in nine ambulances were delayed by more than 60 minutes, a 10.2% increase on the previous week, setting a new record high for this reporting period.
The average number of delays for this winter has continued to creep up, increasing from 0.3% up to 21.3%. The previous highest weekly average number of delays was 14.3% in 2019-20.

The Royal College of Emergency Medicine and The College of Paramedics have collaborated on this Ambulance Handover Options Appraisal guidance that details the ways in which Paramedics and Emergency Medicine staff can reduce ambulance handover delays.

Dr Ian Higginson, Vice President of The Royal College of Emergency Medicine, said: “The data show Emergency Department crowding, long “hidden” within the walls of EDs, has become more visible as handover delays have dramatically increased, leading to ambulances waiting outside EDs with their patients still inside.

“It is vital that ambulances return to active service whenever possible and safe to do so. Delaying ambulance handovers should be a last resort. Holding patients in ambulances leads to unnecessary delays to their care, leaving seriously ill or injured patients in the community requiring an ambulance to wait longer.

“Ambulance handover delays are almost entirely caused by dangerous crowding in Emergency Departments. The root cause of these problems is “exit block” where there are delays for patients to be admitted to inpatient beds from the ED. Patients suffer harm or die unnecessarily when they cannot get an ambulance in time, when they are held in ambulances on arrival in ED, or when they are treated in crowded EDs.

“Emergency Departments must have sufficient capacity to meet demand, and constant flow from the Emergency Department into inpatient beds, otherwise they will not be able to keep patients and staff safe. This means that risk must be properly shared within organisations, and through systems.

“When this does not happen leadership teams tend to look for mitigation. Unfortunately, this mitigation is usually focused at the front door of the hospital, rather than being directed at the root cause of the problem. The Royal College and The College of Paramedics have produced this joint guidance to support good decision making when managing ambulance handover delays in an effort to tackle ambulance handover delays and dangerous Emergency Department crowding.”

Tracy Nicholls, Chief Executive of The College of Paramedics, said: “We hear from our members how consistently challenging this situation is and, whilst we can see that paramedics, ambulance clinicians and hospital ambulance liaison officers are doing everything they can, the system is now at breaking point.

“Those who need an ambulance are continuing to wait an unacceptable length of time and those paramedics and ambulance clinicians who are running to their next job can clearly see how long their next patient has been waiting and know they are going to be met with frustration, anxiety or fear.

“It seems incongruous that additional measures are being taken at the front door when the whole system flow of patients still needs to be addressed, but we suspect that there are now few options left without further risk to both those who are using the ambulance services and those who are working within them.

“Ambulance operations centres are still fielding calls at record numbers because callers want to know when an ambulance will arrive and are often calling back time and time again.

“It is difficult to hear that an ambulance might be delayed but imagine how a caller feels when their 999 call isn’t answered straight away. The moral injury is not just with the paramedics, but also with all of those involved directly with patients and their care.

“The College supports RCEM’s call for both the reduction in ambulance handover delays and in ED overcrowding. It is only by working together as a system that we will see this much-needed change and this guidance document outlines the risks associated with the current challenges.”

Emergency Departments continue to face severe pressures as RCEM calls for meaningful action

The latest A&E activity and waiting times for major Emergency Departments in Scotland for January 2022 show:

73.7% of attendances were seen and resulted in subsequent admission, transfer or discharge within four hours
There were 96,338 attendances, a 1.4% decrease when compared to the previous month, December 2021
More than one in four patients were delayed by four hours or more
6,682 patients were delayed by eight hours or more, a 23% increase when compared to the previous month, December 2021
This is equal to 6.2% of all attendances
2,155 patients were delayed by 12 hours or more, a 30% increase when compared to the previous month, December 2021
This is equal to 2.1% of all attendances

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The health service in Scotland continues to face severe system pressures.

“Emergency Departments remain dangerously crowded with many patients facing extremely long waiting times as ambulances still face delays in offloading patients. These long waits are leading directly to harm for our patients.

“Despite the challenges of widespread bed shortages and staff shortages, Emergency Medicine staff continue to do all they can to keep patients safe. It is the hard work and dedication of EM staff who are preventing urgent and emergency care from tipping over the edge and falling deeper into crisis.

“Frontline workers continue to be pushed to their limit and are experiencing significant moral injury as a result of inadequate bed capacity and patient flow. It is clear that without significant, immediate change, both patients presenting to our Emergency Departments, and the staff working in them, face ongoing harm.

“Emergency Medicine staff will continue to be pushed to their limit unless an adequate urgent and emergency recovery plan is set out by the Scottish Government – this would prevent any threat of derailing elective care recovery.

“In the longer term, the Royal College continues to call for a fully funded long-term workforce plan and for 1,000 additional beds to be opened in the system. The current status quo is not sustainable for patients or staff, it is time to see meaningful action.”

Long waiting times continue to put patient safety at serious risk

The latest A&E activity and waiting times for major Emergency Departments in Scotland for December 2021 show:

73.7% of attendances were seen and resulted in subsequent admission, transfer or discharge within four hours
There were 97,644 attendances, a 6% decrease when compared to the previous month, November 2021
More than one in four patients were delayed by four hours or more
5,342 patients were delayed by eight hours or more, equal to 5.5% of all attendances
1,605 patients were delayed by 12 hours or more

Responding to these figures, Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “With fewer attendances performance has plateaued but be in no doubt that the health service and its staff in Scotland remain under unprecedented pressure and increasing burnout.

“One in four patients face delays over four hours, while both eight- and 12-hour waits are still at record high levels not seen before 2021. What is deeply concerning is the pattern and the potential for these long waiting times to become the status quo in perpetuity.

“Both our own report Crowding and its Consequences (below) and a recent article in the Emergency Medicine Journal ‘Association between delays to patient admission from the emergency department and all-cause 30- day mortality’ detail the real harm, and in some cases death, that long waiting times can cause patients.

“The impact of this continued poor performance is distress and moral injury to staff and serious discomfort and risk to the safety of patients. This must be an urgent signal and call to action for system change. We have long called on the government to open 1,000 more beds in the system in Scotland, and to commit to publishing a long-term workforce plan. While there remains an urgent need to address the social care crisis to help patients be discharged from hospital in a timely way.

“Quite simply things cannot continue as they are, more patients will come to harm and staff will face increasing distress at the quality of care they are or, more significantly, aren’t able to provide. The government must recognise the severity of the situation and the risk that continued poor performance, long waiting times, patient harm, and sinking quality of care will continue to spiral.”

RCEM_Why_Emergency_Department_Crowding_Matters Download

Emergency care crisis deepens

The latest Urgent and Emergency Care Daily Situation Reports 2021-22 for week ending 2 January 2022 show:

There was a total of 562,062 instances of staff absences
249,173 instances of staff absences were covid related, an increase of 41% on the previous week
Nearly half of instances of staff absences were covid related
Since the start of December there has been an increase of 198% in covid-related instances of absence
On average 16,906 patients resided in hospital who no longer fit the criteria and were ready to be discharged, of these, on average, 9,858 remained in hospital
This is equal to almost six in 10 patients who were ready to be discharged remaining in hospital
Nearly one quarter of ambulance arrivals were delayed by 30 minutes or more
Almost one in 10 ambulance arrivals were delayed by at least an hour

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The scale of the pressures facing the health service is highlighted in these figures. Instances of covid-related absence have tripled since the beginning of December. Now the army has been deployed to assist the health service in London.

“Ambulances continue to be delayed in handing over patients on arrival putting patient safety at risk, while high numbers of patients ready to be discharged remain in hospital due to the ongoing social care crisis.

“Promoting flow through the hospital is vital but rests upon timely discharge of patients back home once their treatment is complete. To ensure this social care must be resourced and supported, this will help reduce admissions and free up beds in hospital.

“It is a perilous situation, and an enormous strain is put upon staff working in hospitals, who continue, as ever, to go above and beyond to ensure care continues to be delivered and patients are kept safe.”

RCEM: Health system under enormous strain as Covid impacts emergency care

The latest A&E activity and waiting times for major Emergency Departments in Scotland for November 2021 show:

73.8% of attendances were seen and resulted in subsequent admission, transfer or discharge within four hours – an increase of 3 percentage points compared to the previous month, October 201
There were 103,726 attendances, a 4% decrease when compared to the previous month, October 2021
More than one in four patients were delayed by four hours or more
5,697 patients were delayed by eight hours or more, equal to 5.5% of all attendances
1,729 patients were delayed by 12 hours or more

Responding to these figures, Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The reality on the ground is that many Boards are under enormous strain, as there has been a significant increase in staff absences due to the surge in covid. Staff are isolating with a positive test or due to a contact with someone with a positive test.

“Emergency Departments were overstretched prior to the new variant. But current winter pressures met with widespread staff absences mean staff are put under more and more strain on each shift which affects the quality of care provided and both the patient and staff experience alike.

“For many staff, there hasn’t been a Festive break, and they have had no rest or respite but continue to work tirelessly in Emergency Departments.

“The pressures are mounting on the health service once again. It is imperative that we are able to continue delivering vital care to patients.

“But the surge of covid across Scotland is affecting all parts of the system, not just Emergency Care.

“It is a deeply concerning situation to be in, and what concerns us most is the functionality of the health system and our ability to continue delivering urgent and emergency care to those who need it.”

NHSGGC issues urgent public A&E appeal as staff struggle to cope with demand

Amidst unprecedented and unsustainable demand on emergency services, NHS Greater Glasgow and Clyde is urging the public not to attend A&E without a very urgent or life-threatening condition and to use more appropriate services instead.

A&Es across the health board remain extremely busy, with all operating well over normal capacity which is having a huge impact on service provision.

Unless very urgent or life-threatening, patients should not attend A&E without first calling NHS24 on 111. This will ensure they are directed to the most appropriate urgent service for their needs and A&Es are safeguarded those who need them.

Commenting Dr Scott Davidson, Deputy Medical Director for Acute Services for NHSGGC, said: “Our A&Es remain open and continue to assess, treat and admit emergency patients, however they are extremely busy and staff are facing huge challenges to ensure we’re able to treat patients safely and as quickly as possible.

“We continue to see large numbers of people attending with symptoms that could be managed by speaking to a GP, local pharmacy, or, by calling NHS24 on 111 before attending A&E.

“As a result of current demand at A&E, people are facing long wait times and our staff are under severe pressure.

“There are other services geared up and ready to see and treat you. If you’ve had a slip, trip or fall, we have numerous Minor Injuries Units (MIUs) across NHSGGC which can look after you, including if you’ve broken a limb.

“More information on MIUs, what they can treat and how to access one can be found on the NHSGGC website (https://www.nhsggc.org.uk/your-health/know-who-to-turn-to/minor-injury-units/archive/minor-injuries-adults/)

“GP practices across Greater Glasgow and Clyde are operating normal hours, and community pharmacies are also open to help you get the treatment you need.

“Unless very urgent or life-threatening, please do not attend our A&Es unless you are referred.”

Across NHS Greater Glasgow and Clyde there are three standalone Minor Injuries Units (MIUs) – at the Vale of Leven Hospital, Stobhill Hospital and the New Victoria ACH.

MIUs operate in a similar manner to A&Es and can take care of a vast range of injuries.

Patients who attend MIUs following a call to NHS24 are far more likely to be seen, treated and discharged quicker than if they present to an A&E. They will also be helping to protect vital frontline A&E services for those people whose lives are at risk.

More information on MIUs, what they can treat and how to access one can be found on the NHSGGC website: https://www.nhsggc.org.uk/your-health/know-who-to-turn-to/minor-injury-units/archive/minor-injuries-adults/

A & E performance reaches record lows once again as fears grow for coming weeks

The latest weekly update of Emergency Department activity and waiting time statistics show:

Four-hour performance was second lowest on record at 69.7%
There were 24,009 attendances
7,285 patients were delayed by four hours or more, equal to one-third of patients
1,803 patients were delayed by eight hours or more
598 patients were delayed by 12 hours or more

Responding to these figures, Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said:“The latest data is shocking, as performance sinks to record lows once again. Staff are working tirelessly in Emergency Departments, and we anticipate pressures to mount further as covid surges across Scotland, and with this performance to drop even more.

“We are deeply concerned. Our fear is that staff absences due to covid may prevent the health service from delivering effective care. The current pressures are already leading to long waits for patients, ambulance handover delays, dangerous crowding and corridor care. If we lose staff to covid, these consequences will be further exacerbated. We know that long waits in Emergency Departments threaten patient safety and can lead to avoidable harm or death.

“The crisis is extremely worrying. The coming weeks will be a significant challenge, morale is already plummeting as concern for whether the health service in Scotland will be able to cope is escalating.

“We hope the public understand the unprecedented pressures facing the health service and the crisis that is deepening each week. Staff are doing all they can to deliver effective care and to keep patients safe.

“We urge the public to be cautious in the coming weeks, to use face masks, avoid crowded places, get tested and isolate when they have symptoms, and crucially, to get vaccinated or boosted – these steps go a small way to alleviating pressures on Emergency Departments and the wider health service.”