NHS should avoid focus on four-hour A&E target

The Society for Acute Medicine (SAM) has urged the NHS not to focus on the four-hour A&E waiting time target alone as it attempts to measure pressure on hospitals this winter.

It said other factors, such as the number of black alerts and capacity-related major incidents, daytime bed occupancy figures, patients moved to non-specialist wards and timeliness of senior clinical reviews, should all be considered.

“The winter of 2014-15 was not pleasant and to ensure it doesn’t happen again and to make things better, we need to articulate a clear picture of the problem,” explained SAM president Dr Mark Holland.

“We have suggested four simple measures of activity that acute medical units could collect so a more meaningful and common language can be used to describe winter pressures, as opposed to simply focusing on the four-hour emergency access target.”

SAM is the national representative body for the specialty of acute medicine, which deals with the immediate and early treatment of adult patients with a variety of medical conditions who present to hospital as emergencies.

The proposed measures of activity form part of the group’s ‘Planning for Tomorrow, Today’ campaign, which urges acute medical units (AMUs) to collect wider data to demonstrate “why things are bad”, with examples so problem areas can be highlighted and tackled.

Dr Holland said a “key concern” for acute physicians was the inappropriate transfer of patients out of A&E and AMUs to non-specialist wards, which he said was “wrong” and “should be reported as clinical incidents”.

“Our colleagues in emergency medicine use the term ‘exit block’ for times when patients need a bed but one is unavailable,” he explained.

“In acute medicine, we are frequently unable to send patients to a ward as there are no specialty beds, which hinders patient flow into AMU and the knock-on effect is that patients are sent directly from AMU to a ward which cannot meet their needs.”

Older people and patients with complex care needs, or multiple conditions, make up the largest proportion of patients seen in acute medicine – and Dr Holland called for a focus on how hospitals care for the elderly this winter.

Dr Holland, a geriatrician by training, said: “I am aware of some excellent models of acute care for older people, where they receive the right attention the moment they enter hospital, so we are encouraging all units to share their experiences and services with SAM in order to get these processes rolled out nationwide.

“One clear and consistent message is that a prolonged hospital stay and confinement to bed is not in the long-term best interests of older people.”

He added: “Providing the best medical, nursing and therapy care is not difficult. Recipe book medicine is not the solution; the challenge is meeting the needs of the individual, every time.

“For older people, that means we need teams of doctors, nurses, therapists, pharmacists and social workers to provide ‘comprehensive geriatric assessment’ the minute patients arrive in an acute medical unit so we can afford older people the care they need and deserve from the outset.”

For more information on SAM’s ‘Planning for Tomorrow, Today’ campaign, visit

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