> I don't entirely understand your option 2.
> ....but would ask why it's not acceptable?
>
> It really would be helpful to have access to at least a transcript of Cliff's
> presentation.
> Anyone?
>
> Goat
>
> >
> > 2) Accept that queues form but make them orderly (again, not
> > acceptable in the NHS in the current climate)
> >
Option 2 would be getting rid of the 4 hour target. Patients wait as long as it takes for them to be seen with or without triage so that the sicker patients get seen earlier. It smooths out the peaks and troughs in attendances (you don't need as many staff to see 99% of patients within 6 hours of attendance as you do to see 99% within 2 hours of attendance) and also acts as a deterrent to patients. (Effectively you introduce a charge to the patients but it is a charge in terms of waiting time rather than cash). Politically difficult though: the public have good used to being seen promptly on arrival and a politician seeking to change this would have problems. Within departments it is tricky as well. I don't think anyone is talking about patients with chest pain or falls waiting a long time to be seen. It would be in minors. But a lot of departments have brought in see and treat in minors and find it works fairly well for them. Getting rid of it would have the problems of natural resistance to change.
There are a few other problems with long waiting times as well:
1. It doesn't work as a deterrent. Attendances rose well before the 4 hour target came in and have risen in other countries that did not bring in the 4 hour target.
2. Triage takes some of your resources. Using experienced staff to decide how long a patient should wait rather than seeing them and preventing that wait is a waste of resources. It may be a necessary waste of resources but it is still a waste.
3. Workload can increase. Discharging a patient with a minor problem and no treatment takes less time in explanation if they have waited 30 minutes than if they have waited 5 hours
4. Triage gets it wrong sometimes. Anyone who has been around for a few years will have seen patients who in retrospect should have been seen sooner.
5. In economic terms, the waiting time is a deadweight loss. It creates a cost to the patient without creating any advantage to anyone else.
Matt Dunn
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