Recalibrating the 4 hour target - is it going to help?
Pressures don’t seem to ease off, no matter what season or day of the week it is. The baseline seems to have realigned to busy with the hectic days interspersed.
If you look at the 4 hour target, as Partha Kar suggests, as purely a performance indicator then it shows that despite the superhuman effort, clever ideas, and careful coding most A&Es simply can’t keep up with the volume and complexity of patients. And does it really indicate success or failure? No one seems to know but it’s the only measure that gets the headlines.
One possible alternative could be a stratified time target based on triage assessment. For instance the chest pain could have a 2 hour target whereas the broken nail could be given a 6-8 hour target. Or back to the early days with no time target at all and patients seen purely on the basis of their symptoms and clinical severity?
But if we change the system we risk losing our ability to compare to previous years and risk creating a worse situation than before. Either way it won’t fix the problem.
The arbitrary inflexible 4 hour target doesn’t reflect the rising demand on the whole system and there is no one solution. But the bodies on the ground in A&Es are stretched to breaking point.
Regarding ‘patient flow’ sometimes it feels as though we are tightening the margins rather than facing the problems. We need more physical space, beds and social support, not to mention more staff across the system. If you start the night shift with 5 spare beds across the whole hospital there is only so much you can do. With winter approaching the odds are it isn't going to get better, it's going to get worse. As a wider system we’re close, very close, to black alert becoming the norm.
Rapid Response:
Recalibrating the 4 hour target - is it going to help?
Pressures don’t seem to ease off, no matter what season or day of the week it is. The baseline seems to have realigned to busy with the hectic days interspersed.
If you look at the 4 hour target, as Partha Kar suggests, as purely a performance indicator then it shows that despite the superhuman effort, clever ideas, and careful coding most A&Es simply can’t keep up with the volume and complexity of patients. And does it really indicate success or failure? No one seems to know but it’s the only measure that gets the headlines.
One possible alternative could be a stratified time target based on triage assessment. For instance the chest pain could have a 2 hour target whereas the broken nail could be given a 6-8 hour target. Or back to the early days with no time target at all and patients seen purely on the basis of their symptoms and clinical severity?
But if we change the system we risk losing our ability to compare to previous years and risk creating a worse situation than before. Either way it won’t fix the problem.
The arbitrary inflexible 4 hour target doesn’t reflect the rising demand on the whole system and there is no one solution. But the bodies on the ground in A&Es are stretched to breaking point.
Regarding ‘patient flow’ sometimes it feels as though we are tightening the margins rather than facing the problems. We need more physical space, beds and social support, not to mention more staff across the system. If you start the night shift with 5 spare beds across the whole hospital there is only so much you can do. With winter approaching the odds are it isn't going to get better, it's going to get worse. As a wider system we’re close, very close, to black alert becoming the norm.
Competing interests: No competing interests