This a terrible problem to have to deal with, Danny. As the others have
pointed out the really distressing thing is that this has nothing to do with
the A&E department at all. It is totally clear in our own department that
when there are beds available in the acute wards that it is very easy to
keep the department safe and waiting times rarely rise above 90 minutes even
during the very busy periods. Where the wheels fall off is where we cannot
move patients out of A&E when the whole department rapidly clogs. This is
when you get trolleys ouside cubicles, in minors and in the middle of the
department. It also means that you cannot see new patients coming in through
the door. Our own experience is that this is entirely related to hospital
bed capacity and nothing to do with how hard we are working.
We have been able to deal with temporary increases of up to 50-75% in our
average daily attendances without significantly increased trolley waits - as
long as beds are not a problem.
If more proof were needed, Ian Steill has just published a very nice paper
in Academic Emergency Medicine showing yet again that ED waiting times are
related to hospital bed occupancy.
Danny, I would bet this is the root cause of why our departments are having
more problems now than they were even 5 years ago. Our managers seem to be
unable to grasp this despite us explaining it VERY LOUDLY.
This is particle physics. DOH A&E advisers, are you listening?
Phil Munro
A&E Glasgow
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