Tag: Emergency Departments

Emergency! Key staff shortages are increasing the pressure on struggling ED workforce

Census by RCEM Scotland shows a shortage of key senior decision-making clinicians and a workforce below adequate staffing levels

A census of the Emergency Medicine workforce in Scotland by the Royal College of Emergency has found shortages of key senior decision-makers, and a workforce that is below adequate staffing levels to deliver the best and most effective care to patients.

When asked for immediate staffing needs, Emergency Departments across Scotland reported they needed an increase of:

  • 25% in consultants
  • 45% in Advanced Clinical Practitioners/Advanced Nursing Practitioners/Physician Associates
  • 16% in Emergency Nurse Practitioners
  • 22% in Higher Specialist Trainees/Non-consultant Senior Decision-Makers
  • 21% in Junior Doctors

RCEM analysis shows that to resolve the shortages of senior decision-makers and to achieve adequate staffing and aspirational staffing levels by 2026 the current workforce in Scotland needs a total of 405 more health care staff broken down as:

  • 113 more consultants
  • 74 more Higher Specialist Trainees/Non-consultant Senior Decision-Makers
  • 38 more Advanced Clinical Practitioners/Advanced Nursing Practitioners/Physician Associates
  • 180 more Junior Doctors

RCEM’s Scotland workforce census consisted of a 64-question survey and was sent to Emergency Department Clinical Leads across Scotland.

Responses were received from 24 Emergency Departments, including all 20 consultant-led Emergency Departments, one Minor Injury Unit, and three Remote and Rural Hospitals.

Commenting on RCEM’s Scotland workforce census, Dr John Thomson, Vice President (Scotland) of the Royal College of Emergency Medicine, said: “The census clearly shows that the Emergency Medicine workforce in Scotland is not adequately staffed to deliver the highest quality patient care.

“This has led to an increase in intense pressures on the existing workforce and is very likely to be a contributing factor to the continued deterioration in performance.

“We have always been proud of Scotland’s performance in Emergency Medicine, ensuring quick and effective care that outperformed the rest of the United Kingdom. But, even before the pandemic, the increase in demand put severe pressure on staff, and departments began to struggle to meet the four-hour access standard, but more seriously began to struggle to deliver appropriate treatment to patients, resulting in more delays and longer stays.

“The pandemic certainly exacerbated these issues and now there are some major challenges that face Emergency Medicine in Scotland. Emergency Medicine can be relentless; a service delivered 24 hours a day, seven days a week, will always take its toll, and the pandemic has highlighted the severe burnout that Emergency Medicine staff, especially face.

“Departments must be staffed with a workforce trained and qualified in Emergency Medicine. Shortages in senior decision-making staff groups can lead to Emergency Departments over-depending on junior staff. The census shows that we need considerable expansion of funded consultant and senior decision-maker posts in order to prioritise patient safety and quality of care.

“We managed to survive the first two waves of pandemic with an insufficient workforce, but now these existing staff are facing burnout and exhaustion – with some clinicians reporting they are planning on retiring early. This census clearly shows that we must act and address these problems without delay.

“The Scottish Government must work with the specialty to devise an adequate workforce plan for the emergency care system, taking into account population needs and rising demand on the service. Plans must ensure sustainable and fulfilling careers for all staff, allowing for the delivery of quick, safe, and effective care for patients.

“Without a sufficient workforce plan that addresses the findings of the census, it is likely that there will be continued deterioration in Emergency Department performance and rates of burnout will continue to increase amongst Emergency Medicine staff.”

Prepare Emergency Departments now for the next phase of challenges, says RCEM Scotland

The latest data released today by the Scottish Government for March 2021 show that attendances at Emergency Departments are beginning to return to pre-pandemic levels.

In March 2021 there were 90,833 attendances to major Emergency Departments across Scotland. This is a 30% increase compared to February 2021 and a 7% increase when compared to March 2020.

Despite this increase, 87.5% of attendances to major Emergency Departments in Scotland were seen within 4 hours, meaning one in eight patients are waiting for four hours or more before being seen. Although, this represents an increase of 1.6 percentage points compared to February 2021.

In March 2021, 315 patients spent 12 hours or more in an Emergency Department, this is down by one third compared to February 2021 and down by over one quarter compared to March 2020.

Data also show that 1,358 patients spent eight hours or more in a major Emergency Department, this is down by over 22% compared to the previous month and down six percentage points on the previous year.

Dr John Thomson, Vice President of the Royal College of Emergency Medicine, said: “We are beginning to reach pre-pandemic levels of hospital activity and demand for urgent and emergency care services. We fear a return of the pre-pandemic crowding that put patient safety at risk.

“The health service is in recovery, elective care waiting lists are growing, attendances at Emergency Departments are increasing, and the already depleted workforce is exhausted.

“As a result, some hospitals are beginning to face pressures with patients delayed for hours. We must rapidly assess and address our resources, capacity, and the way we deliver care.

“The College launched its campaign Summer to Recover: Winter Proofing the Urgent and Emergency Care system for 2021 which presents a series of actions the Scottish Government, NHS Boards and ED Leadership Teams can take to prepare their departments for the challenges ahead.

“There are threats of a further wave of covid in the late summer and a potentially gruelling winter with seasonal flu in the community. We saw how the NHS in Scotland was underprepared and under-resourced for the pandemic and the brutal winter which followed, now we have a chance to learn and do what we can to ready ourselves for the next phase.

“Staff are exhausted after a difficult year and are facing new challenges on every front, by preparing now and ensuring that departments are ready for this next phase, we may be able to manage demand and cope with system pressures.”