The four hour target was scrapped last year and since then A&E waiting times have increased. A study carried out in Dublin, presented today at the Society for Acute Medicine Conference in Bristol, has confirmed that the longer patients have to wait for care, the more likely it is they will not survive.
At the same event, the Society for Acute Medicine (SAM) called for the full introduction of seven day working in acute units.
Increasing wait times
Data from over 20,000 acute medical patients collected between 2002 and 2008 shows an increase in mortality as wait time increases. The study used 30 day in-patient mortality as its outcome measure. There was an approximate threefold increase in mortality rate as wait time increased from less than 2.5 hours to greater than 9 hours. This happens at all levels of disease severity.
Researcher Dr Declan Byrne said: “This data adds credence to the position articulated by the Society for Acute Medicine that the 4-hour target has value in driving efficiencies and quality of care. In response [to the study results] we enhanced staffing levels at peak activity times to try and improve patient flow and reduce wait times.’
Dr Philip Dyer, President of the Society for Acute Medicine, has spoken against the scrapping of the four hour target. At the recent conference he said: “At this event we’ve noticed acute physicians are concerned about the increasing delays in A&Es over the last twelve months which are to the detriment of patient experience and potentially patient safety. We’re keen to work with other groups to reverse this trend.”
The necessity of seven day working
Evidence presented – drawn from several studies – showed that seven day working lowers morbidity and mortality rates, improves patient experience, lowers length of stay and reduces rates of hospital acquired infections. However the measures have only been patchily implemented in the NHS.
Professor of Acute Medicine at Imperial College London, Derek Bell, stressed that if seven day working is not implemented that: “At a fairly important time in acute medicine in the UK, I think we are in grave danger of turning the clock back 10-15 years.”
Seven day working could require double the number of available consultants that are currently working, however, the associated efficiency savings could off-set a large part of those costs, and the health benefits could be vast.
President of the Society for Acute Medicine, Dr Philip Dyer, said: “We know that demand doesn’t fall significantly over weekends, and evidence shows that patients are more vulnerable during the evenings and weekends, hence the need for better out-of-hours cover.”
Notes for editors:
• The Society for Acute Medicine Spring Meeting runs from 5th-6th May in Bristol.
• Dr Derek Bell spoke on Thursday 5th May; Dr Declan Byrne spoke on Friday 6th May.
• Dr Declan Byrne is a Consultant Physician in the HSE South at Kerry General Hospital.
• The research was carried out in St James’s Hospital, Dublin and the head of research group was Dr Bernard Silke – Director of the Acute Medical Admissions Unit.
• The Society for Acute Medicine is the National representative body for the speciality of Acute Medicine.
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