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Patients admitted as emergencies should see consultant in 12 hours, NCEPOD recommends

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39359.687025.DB (Published 11 October 2007) Cite this as: BMJ 2007;335:738
  1. Zosia Kmietowicz
  1. London

    Nearly four in 10 patients who are admitted to hospital as emergencies receive suboptimal care that in many cases is detrimental to their outcome, a UK study has found.

    The latest report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) says that such patients should be seen by a senior doctor within 12 hours and that standardised forms should be introduced across the NHS to make it clear that this has happened.

    NCEPOD, an independent charity that aims to improve the delivery of health services, reviewed the care given in the first 24 hours and over the next seven days to more than 3000 adults admitted to 363 hospitals in England, Wales, Northern Ireland, and the Isle of Man on two predetermined dates in February 2005. It found that trainee doctors are failing to recognise the severity of very sick patients when they are first seen in accident and emergency departments.

    The report cites the example of a patient who was admitted to hospital from a nursing home and was assessed in the emergency department by a junior doctor but was given no treatment plan. When the patient was assessed by a consultant 17 hours after arriving in the emergency department the patient's condition had deteriorated. Despite aggressive treatment the patient died 24 hours later.

    Overall the review found that 40% of patients were not seen by a consultant within 12 hours of admission. In half the cases poor documentation made it impossible to determine when a consultant saw the patient.

    The authors judged that in 16% of cases the time to the first review by a consultant was unacceptably long, which may have worsened the outcome.

    Part of the problem may be the fact that consultants caring for 69% of the patients had other duties to perform while on call, and 21% were doing more than three duties at the same time. In addition, 15% of units did not have 24 hour access to computed tomography and 7% did not have access to conventional radiography.

    The report calls for all patients admitted as emergencies to be seen by a consultant within 12 hours and for consultants on call to be available to deal with emergency admissions. Standardised forms should be used across the NHS to make it clear when patients have had a consultant review, it says.

    Better training will help junior doctors recognise critically ill patients and make appropriate clinical decisions, says the report. And all hospitals that handle emergency admissions should have access to conventional radiography and computed tomography around the clock, it says.

    Footnotes

    • Emergency Admissions: A Journey in the Right Direction? is available at www.ncepod.org.uk.

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