Latest waiting time figures for emergency departments in England are worst on recordBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1658 (Published 12 April 2018) Cite this as: BMJ 2018;361:k1658
All rapid responses
I understand it could be annoying for patients to wait over 4 hours in the emergency department, and for the staff to deal with a long queue.<1> However, I wonder whether auditing on waiting time could have a negative impact on patient care.
One reason for the long wait time could be due to teams spending too much time arguing against admissions, rather than doing hands-on clinical work.<2> In their defence, it is difficult to decide on admission with insufficient investigations and unclear diagnoses. No physicians would like to admit and treat patients beyond their level of competence.
When facing pressure to the meet the 4-hour target and reduce the long queue, the emergency team could struggle to have done the investigations and establish clear diagnoses for all patients. However, hastily admitting medical patients to the surgical unit or vice versa could be detrimental to their care, and further delay providing the right treatment. Similarly, unnecessarily admitting patients could waste healthcare funding, and lead to iatrogenic harm such as nosocomial infection.
I am sure many hospital doctors have received referrals when patients have no basic investigations done. For example, otolaryngology colleagues could be requested to admit a patient with epistaxis in the emergency department, but no bloodwork be taken. And when they request bloodwork, they are likely to be told simply that the emergency department is not a phlebotomy service.
We are doing a disservice to patients when being rushed to admit patients or make referrals without adequate assessment. This 4-hour wait time target may look good on paper, but potentially it does harm patients. At the end of the day, are we treating the patients or numbers? The point of conducting an audit is to improve rather than worsen quality of patient care.
1. Torjesen I. Latest waiting time figures for emergency departments in England are worst on record. BMJ. 2018;361:k1658.
2. McCartney M. Margaret McCartney: Let’s start talking to colleagues. BMJ. 2018;361:k1602.
Competing interests: I have been paid for working as a medical doctor, but not writing this letter.
24 months since my last comments on waiting time figures (https://www.bmj.com/content/352/bmj.i2179/rr-0)
Going through it, I would not change a single word to comment on this latest news
Time to stop measuring 4-hour target compliance and start looking at bed occupancy, which is probably the real indicator of hospital overcrowding and mortality
Competing interests: No competing interests