A&E departments are experiencing a perfect storm of factors leading to an increase in waiting times

February 2017

Emergency Care

Country of origin: UK

As hospitals throughout the country increasingly fail to hit A&E targets, patients in England have been warned they could expect greater waits in emergency units.

Days after NHS England data revealed major emergency units had missed the target to treat, admit or discharge emergency patients within four hours for an unprecedented 52 weeks in a row, a wide-ranging new analysis from the Nuffield Trust and Health Foundation uncovers the reasons behind these breaches.

The report tracks a number of contributing factors leading to struggles in A&E. It shows that crowding (the number of people in a department at any one time) is closely linked to waiting times. Crowding has risen as the population has grown and aged, while the number of A&E units has been frozen or reduced under successive governments. There was an 8% increase in crowding between 2010/11 and 2012/13 despite only a 3% rise in attendances a trend which is likely to continue.

The analysis shows that winter pressures were associated with higher rates of people waiting more than four hours, but by less than most people think. Challenging conventional wisdom, it highlights the strain hot weather puts on A&E departments - when average daily temperatures hit 20C compared with 5C, trips to A&E rise by nearly 20%. However, very cold weather does also cause longer waits, and raises the chances of patients needing to be admitted to hospital.

Tracking 41 million A&E attendances from 2010 to 2013, the report exposes an age gap where older people wait in A&E longer than children and younger adults. This is due in part to the complexity of conditions which older people suffer, which often require longer periods of care but older adults have also seen the fastest increase in waits which breach the four hour target. People over 75 spent around three and a half hours in A&E on average, compared with two and a half hours for under-75s.

Patients who suffer from long-term conditions like arthritis also wait longer to be admitted or discharged, and those with more than one condition wait longest of all. However, aging and long term conditions only explained a small amount of the increase in breaches of the four hour target.

The analysis shows that people whose local GP practice had better patient feedback were less likely to attend emergency units. Practices which were rated as easy to reach by telephone also saw fewer patients go to A&E. However, GP satisfaction did not make a difference to breaches of the four hour target.

Underlying this wider picture, links were also found between long A&E waits and the availability of beds on hospital wards.

Resources

Clinical Pain Advisor April 2018 Clinical Pain Advisor is a free, simple to use, medical app that offers pain medicine healthcare professionals a...
Managing Head Injury April 2018 The National Institute for Health and Clinical Excellence (NICE) has issued an updated guideline on the early care of...
Calculate by QxMD March 2018 Medical calculators come in all different shapes and sizes from traditional paper OB wheels to the more tech-savvy app...
ECG Guide QxMD Medical Software March 2018 QxMD are consistently creating excellent apps aimed squarely at the health professional and have made a few apps that...
Read by QxMD March 2018 There are a few ways to browse journal content. The landing screen is Featured Papers, which presents citations from your...
Pedi STAT March 2018 In a medical emergency, time is of the essence. Timely medical and procedural interventions are often needed to keep...
Better access to medicine safety data March 2018 Patients and researchers are able to look at data on the safety of different medicines. Part of a series of measures to...
EMRA PressorDex for emergency medicine physicians February 2018 Newly revised and updated for 2015, PressorDex is a comprehensive therapeutic guide to the myriad of pressors, vasoactive...
BMJ Best Practice February 2018 Fast and easy access to the latest evidence based information on diagnosis and treatment for healthcare...
Orlive Surgical Broadcasts February 2018 Orlive is a trusted world resource in surgical broadcasting for physians, surgeons and caregivers.
Search by Keyword