I agree with Rowley it helped to improve & develop
hospitals.systems in the early days. However this winter
has clearly shown that it is not only a EM problem.
Capacity has been the name of the game!
As with all Standards it needs to be SMART i.e.
Specific, Measurable, Achievable, Reliable,
and Timed.
.
My concern is based on the fact that undoubtly loop holes
in the original target have been found so although
departments may have experienced prolonged waits to off
load patient from ambulances due to lack of available
trolleys. This lack of hospital capacity as seen clearly
this winter with higher proportion of patients needing
admission with waits being prolonged has not been
reflected in the 98% results. It is just a well the DoH
has stimulated that ambulance need to off load within 15
minutes so that you can get a good idea how hospital are
doing by looking at ambulance data.
I don't feel that this standard actually is reliable or
directly indicates the quality of care or the actual time
spent in the ED. I don't personally have a problem in
the principle with a standard if it was measured
consistantly across the whole country, so long as the
patient's interest/care pathway is the driving force and
not the standard.
Salim
On Fri, 20 Mar 2009 10:11:00 +0000
Rowley Cottingham <[log in to unmask]> wrote:
> 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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