Patients wait longer in emergency units than five years ago
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7319.953 (Published 27 October 2001) Cite this as: BMJ 2001;323:953
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The audit commission states that waiting times in A&E have
increased despite an increase in the number of A&E doctors. In
addition, they point out that waiting times vary from department to
department, and that waiting times do not correlate to the numbers of
attendences per doctor.
The audit commission does not consider the 'quality' of care given to
the patients (except for thrombolysis times). Some departments act as
'triage posts', redirecting patients to other specialities within the
hospital, whilst others attempt to solve the patients problems and
discharge them home from A&E. Which one of these is more valuable to
the emergency care structure as a whole?
The aim of reducing waiting times for patients is laudable, however
should be considered together with the service offered. The target of no
patients spending more than 4 hours in an A&E department by 2004
misses a valuable opportunity for patient care. Sometimes care in A&E
may take longer than this, but saves the patient and hospital valuable
time and resources further down the line.
Perhaps in future we should record times from arrival to eventual
discharge from the hospital, rather than just the A&E department. Or
even more relevant to the patient, time of first presentation to medical
services to the time the condition is diagnosed and treatment initiated.
Competing interests: No competing interests
Patients don't mind waiting as long as their problems are sorted out.
I think focus on waiting time in A&E is totally unnecessary. Most
departments have stock of reading material and TV in waiting areas and
opportunities for social interactions. The waiting rooms are generally
warm and comfortable, and one does not have to pay for the treatment. So
what is the problem? Most patients would be going home rather than
returning to work or to some pressing social engagement, so by staying a
bit longer in A&E, they are actually saving on their domestic Gas and
Electricity bills. Ask the real patients they just do not mind and are
happy to hang around!
Competing interests: No competing interests
The audit of accident and emergency department states that
waiting times increased although the 1% increase of patient load was more
than matched by a 10% doctors number rise.
Well, it just may be that physician staffing still is far
from sufficient although it (slightly) increased since 1998! There is no
linear relation between patient numbers and
waiting time. The relation might be exponential, given the
disorganization induced in A&E Departments by excessive
patient/physician ratios.When the audit commission suggests
nurse practicionners would help, it unwillingly admits physicians are
not in suficient numbers.
Why this emergency physician shortage ? Did the venerable
audit commission consider the hypothesis that a too heavy
workload, too few physicians to cope with too many patients,
daily difficulties at work , bed shortage, violence in
emergency wards, all were strong disincentives to
considering starting or continuing a career in emergency
medicine ? And that improving the workplace, increasing
staff, finding solutions to bed shortage, improving wages,
all would make this specialty more attractive ? Computers are inexpensive,
they may help but won't replace missing
(expensive) doctors.
Competing interests: No competing interests
The Big Picture
It is very important for patients not to be waiting in the ER for
what to some appear to be Aeons .However it is even more important that
when one leaves the ER esp to be discharged, that there be insite to their
illness rather than a treatment of only their symptoms. In many instances
it is like the story of the blind men sensing different parts of the
elephant and calling it what they had detected rather what it in fact
was.... An elephant. Sometimes to see this big picture requires the
additional 2-3 mins/patient thus leading to the decrease in number of
multiple presentations of one patient. Who Knows, this may just have to
impact of improving ER effeciency after all. It also has implications for
litigation.
Competing interests: No competing interests