Tag: Royal College of Emergency Medicine

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.”

Weekly Scottish Emergency Department waiting times are ‘worst on record’

Serious concerns for patient safety

The latest weekly update (w/e 20 March 2022) of Emergency Department activity and waiting time statistics show:

  • There were 25,506 attendances in week ending 20 March 2022
  • Four-hour performance was 66.2%, the lowest on record
  • 8,610 patients were delayed by four hours or more, this is the highest on record and means one third of all patients were waiting for four hours or more in an Emergency Department
  • 2,615 patients were delayed by eight hours or more, this is the highest on record and means more than one in 10 patients were waiting for eight hours or more in an Emergency Department
  • 1,015 patients were delayed by 12 hours or more, this is the highest on record and means one in 25 patients were waiting for 12 hours or more in an Emergency Department

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “Each week the Urgent and Emergency Care crisis worsens.

“Scotland’s Emergency Care system is failing patients who are coming to harm, and failing staff who are overworked, exhausted, and burned out but are left to cover the widespread shortcomings of the health system. Shortages of beds, shortages of staff, the social care crisis; existing staff do all they can to keep patients safe in these exceptionally challenging circumstances.

“It is an untenable and unsustainable situation. This week saw the highest number of long waits on record yet again. Data show that there is one excess death for every 82 patients delayed for more than six hours.

“This week 2,615 patients were delayed by eight hours or more, from this we can estimate that over 30 patients in this week alone could have come to associated harm or death as a result of their delay to admission.

“The significance of this appalling harm must not go unnoticed and must be met immediately with effective and meaningful action. The Scottish Government must understand the severity and extent of harm befalling our patients, and see that existing staff facing moral injury, going above and beyond, running on goodwill and adrenaline is not reasonable or acceptable.

“This can no longer be the sole answer to the biggest patient safety crisis in Emergency Care for a generation. This must not continue.”

Emergency Care faces continued pressure as Scottish Government publishes workforce strategy


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

  • There were 24,920 attendances, the highest since week ending 10 October 2021
    70.5% of attendances were seen and resulted in subsequent admission, transfer or discharge within four hours
  • 7,347 patients were delayed by four hours or more, this is the third highest on record
    1,825 patients were delayed by eight hours or more
  • 643 patients were delayed by 12 hours or more, this is the second highest on record

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The data show the stark picture of the health system in Scotland right now and the serious crisis Urgent and Emergency Care is facing.

“There are extremely high numbers of patients being delayed for long periods of time, and we know that these long waits are associated with a high risk of harm or even death.

“This is a critical time. The pandemic is not over. Covid is ever present in the community, with increasing numbers of covid patients in hospital and a high level of covid related staff absences. The workforce is burnt out and overwhelmed, every shift is extremely demanding with staff covering for absent colleagues and managing high numbers of patients, doing their best to keep them safe and minimise harm. The moral injury to our colleagues working in our Emergency Departments cannot be underestimated.

“We welcome The Health and social care: national workforce strategy published last week by the Scottish Government. It is a positive strategy for the next five years. We especially welcome the commitment to grow the NHS workforce by 1,800 WTE staff and increase the number of medical school places by 500.

“However, we are disappointed both not to have been consulted on this strategy and by the limited mentions of Urgent and Emergency Care. We look forward to the Cabinet Secretary for Health and Social Care consulting with The Royal College on the meaningful details for Emergency Medicine including staffing and capacity needs.”

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_MattersDownload

RCEM response to worst Scottish weekly performance figures ever

The latest weekly update of Emergency Department performance figures for Scotland show:

  • There were 21,163 attendances at A&E services in NHS Scotland.
  • 67.4% of attendances at A&E services were seen and resulted in a subsequent admission, transfer or discharge within 4 hours.
  • 2,079 patients spent more than 8 hours in an A&E department.
  • 690 patients spent more than 12 hours in an A&E department.

This data shows the worst weekly four-hour performance since records began. The highest number of (weekly) eight hour waits since records began, and the highest number of (weekly) 12-hour waits since records began.

More than one in eight patients were delayed in an Emergency Department by eight hours or more.

Responding to this data, Dr John Thomson, Vice President of the Royal College Emergency Medicine, Scotland, said: “This data is deeply concerning and distressing. More than one in eight patients have been delayed by eight hours or more; this is shocking.

The health service is in the middle of a serious crisis. Staff are working exceptionally hard but are burnt out and overwhelmed and face moral injury on every shift.

Patient safety is frequently compromised. We know long waiting times increase the risk of death and patient harm. The exit block that exists in our Emergency Departments which prevents patients moving in a safe, timely manner to an appropriate ward is worsening, causing even more harm to our patients.

“It is a critical time for the health service, and we must see a vision for the future. The government must acknowledge the shortfall in staff and beds as the root of this crisis, and this must lead to a commitment to publish a long-term workforce plan that includes measures to retain existing staff who may be thinking of leaving our NHS following this exceptionally challenging period.

“The government must also commit to opening 1,000 more acute beds across Boards in Scotland, which will promote timely patient flow through the hospital. Lastly, a key cause of exit block are the patients who remain in hospital when they no longer require ongoing Hospital care.

“The ongoing crisis in social care means patients are unable to be discharged home following the completion of their treatment. It is vital social care is resourced and adequately staffed to support the most vulnerable patients in their return to the community.”

Health Emergency: Worst ever four-hour performance “must be a call to action”

“The health service is in the middle of the biggest crisis it has ever faced“

The latest monthly Emergency Department (ED) performance figures published by NHS England for December 2021 show that four-hour performance at major Emergency Departments reached its lowest since records began at 61.2%, meaning nearly two in five patients were delayed by four-hours or more and nearly 1 in 4 admissions experienced a wait of at least four hours from the decision to admit them to admission.

The data also show the highest number of 12 hour waits ever recorded: 12,986 patients spent 12 hours or more from decision to admit to admission. This is a 22% increase on the previous month, November 2021, and it is 250% higher than December 2020.

Responding to the publication of NHS England quarterly and monthly performance figures, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The situation on the ground is extremely bleak. Staff are overwhelmed and burned out; it is increasingly challenging to provide timely and safe patient care.”

Latest Quarterly performance figures published by NHS England show that in 2021-2022 there were a total of 43,218 12-hour delays which is more than all the 12-hour delays over the previous ten years put together (39,608).

The data does not paint the full picture as NHS England record 12-hour waits from decision to admit. Our Winter Flow project, which started at the beginning of October 2021, has so far recorded 71,965 12-hour waits from time of arrival.

It is critical that NHS England commit to reporting 12-hour data from time of arrival and implement the Clinical Review of Standards.

Dr Henderson said: “The health service is in the middle of the biggest crisis it has ever faced, and staff are working harder than ever before with fewer staff and fewer beds.

“When the health service is overwhelmed, it does not cease to function, it is the standards and quality of care that fall. The figures published today show the extent to which these standards have fallen already.

“Performance metrics are intended to hold clinical services to account. They are meant to identify areas in which services are failing with the aim of improving them quickly and effectively.

“The consistent and continuous decline of urgent and emergency care performance, standards, patient experience and patient safety show how this intended function is now entirely lost. With each publication around performance, we commentate with shock and dismay at the latest decline, but our comments are, more often than not, met with inaction or short-term fixes. There needs to be acknowledgment that there is a major public health crisis in emergency care.

“It is the core ability and function of the health and social care service to deliver high-quality and effective care to the acutely ill or injured that is at risk.

“We must now see a vision for recovery and a vision for the health service that includes a vital transformation of the urgent and emergency care system. There must be a plan to implement a framework that is centred around patient care, that drives action and improvement.

“The current framework is simply documenting the health system’s failure to deliver a quality service, and the failure of this framework leaves urgent and emergency care in a performance vacuum.

“We need a decision about either a phased implementation of the findings of the Clinical Review of Standards or an honest discussion about how we performance manage urgent and emergency care differently.

“The current challenges facing the health and social care service are the result of years of stagnation and decline, they are made worse by, but are not just a consequence of, the pandemic. Recognising this is vital to any step towards transformation.

“It is time we saw bolder political willingness to engage on these critical issues. Without action, performance will continue to decline, and this would be a disservice to patients and staff.”

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.”