The 4 hour STANDARD (we aren't allowed to call it a target any more) was
intended to be measured in our departments to drive up improvements
elsewhere in the system. The problem is that it worked for a while to
improve systems and processes; reducing and regularising bed stays,
improving community services and so on. The problems are starting to
reappear within emergency departments because it was seen as a single
shot solution. It was, in as much as an efficiency saving only works once
for a given number of episodes.
What the policy did not take into account was that patients would fail to
keep their part of the bargain and didn't stop coming to EDs. Indeed,
they have been cheeky enough to flood in in ever greater numbers - our
admissions continue to rise inexorably and I doubt we are unique. There
has not been a concomitant expansion in bed numbers to cope with this,
meaning that the pressure falls back in the only department in the
hospital with elastic walls.
The solution then is to review bed numbers or require further 'efficiency
savings' in bed stays or community solutions in the light of these
changes in admission, not to cane EDs ever harder while ignoring
everywhere else. I doubt community solutions are the answer as the acuity
of those arriving seems as bad as ever, and maybe worse than before.
It really isn't our problem, and I detect considerable frustration from
colleagues who rightly feel aggrieved that it has been made ours. Again.
/Rowley./
> *From:* "McCormick Simon Dr, Consultant, A&E"
> <[log in to unmask]>
> *To:* [log in to unmask]
> *Date:* Fri, 20 Mar 2009 09:42:03 -0000
>
> Should we be reducing the target to 95% or improving the systems to
> ensure it gets met?
>
> My department sees just over 200 patients a day and I'm not
> convinced there are 4 patients a day who NEED to be in the ED for
> more than four hours so 98% could be considered reasonable. If the
> standard was dropped to 95% then I'm sure I would feel a little
> less stressed for a while (and like many of you I guess, that would
> be gratefully received) but the problem of bed waits, delays for
> specialties to see patients, transport problems etc would still
> exist but there would be less incentive for the Trust to try and do
> something about them.
>
> The big problem of course is investment and whether pushing the
> four hour standard gives value for money... probably not. That is
> why it isn't invested in and why so many of us are forced to work
> round it and concentrate on quantity rather than quality.
>
> Simon
>
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