Waiting times in accident and emergency (A&E) departments are a key measure of how the NHS is performing. In recent years, patients have been waiting longer in A&E; this article from the Kings Fund explores the reasons behind this.
The article reports that not only are more people are attending A&E departments each year, but A&E waiting times have also increased substantially over recent years. The NHS has not met the standard at national level in any year since 2013/14, and the standard has been missed in every month since July 2015.
At the same time, longstanding staffing issues and continued reductions in the number of hospital beds have made it more difficult for A&E departments to admit patients.
Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients) | Annals of Emergency Medicine
The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying “normal” processes. The study objective is to examine escalation policies in theory and practice.
Editor’s Capsule Summary:
What is already known on this topic
Care delivery organizations commonly develop “escalation policies” for managing crowding and surges in emergency department (ED) demand. The effectiveness of these policies has seldom been studied.
What questions this study addressed
This study used mixed methods to identify common patterns in escalation policies in UK EDs and to evaluate how well they performed in practice.
What this study adds to our knowledge
Formal escalation policies often presumed the availability of resources that were missing or degraded when escalation was needed. Consequently, the actual practice of managing crowding deviated from that inscribed in policy.
How this is relevant to clinical practice
Recognizing and monitoring the gap between formal policies and actual practice should help in the development of more realistic and useful escalation policies.
Occupational stress is a major modern health and safety challenges. While the ED is known to be a high-pressure environment, the specific organisational stressors which affect ED staff have not been established | Emergency Medicine Journal
Methods: We conducted a systematic review of literature examining the sources of organisational stress in the ED, their link to adverse health outcomes and interventions designed to address them. A narrative review of contextual factors that may contribute to occupational stress was also performed. All articles written in English, French or Spanish were eligible for conclusion. Study quality was graded using a modified version of the Newcastle-Ottawa Scale.
Results: Twenty-five full-text articles were eligible for inclusion in our systematic review. Most were of moderate quality, with two low-quality and two high-quality studies, respectively. While high demand and low job control were commonly featured, other studies demonstrated the role of insufficient support at work, effort–reward imbalance and organisational injustice in the development of adverse health and occupational outcomes. We found only one intervention in a peer-reviewed journal evaluating a stress reduction programme in ED staff.
Conclusions: Our review provides a guide to developing interventions that target the origins of stress in the ED. It suggests that those which reduce demand and increase workers’ control over their job, improve managerial support, establish better working relationships and make workers’ feel more valued for their efforts could be beneficial. We have detailed examples of successful interventions from other fields which may be applicable to this setting.
EDs are currently under intense pressure due to increased patient demand. There are major issues with retention of senior personnel, making the specialty a less attractive choice for junior doctors | Emergency Medicine Journal
This study aims to explore what attracted EM consultants to their career and keeps them there. It is hoped this can inform recruitment strategies to increase the popularity of EM to medical students and junior doctors, many of whom have very limited EM exposure.
Methods: Semistructured interviews were conducted with 10 consultants from Welsh EDs using a narrative approach.
Results: Three main themes emerged that influenced the career choice of the consultants interviewed: (1) early exposure to positive EM role models; (2) non-hierarchical team structure; (3) suitability of EM for flexible working. The main reason for consultants leaving was the pressure of work impacting on patient care.
Conclusion: The study findings suggest that EM consultants in post are positive about their careers despite the high volume of consultant attrition. This study reinforces the need for dedicated undergraduate EM placements to stimulate interest and encourage medical student EM aspirations. Consultants identified that improving the physical working environment, including organisation, would increase their effectiveness and the attractiveness of EM as a long-term career.
Overcrowding of the emergency department is a growing problem. Frequent users contribute to the overcrowding problem in emergency departments | International Emergency Nursing
Introduction: Overcrowding in emergency departments is an issue that has a negative impact worldwide. As attendance in emergency departments has increased, the ability to provide critical services to patients suffering from actual medical emergencies in a timely manner has decreased as these departments are many times at or over capacity. One patient population whose negative influence has been researched with regard to their impact on the overcrowding issue is that of the frequent user.
Results: A review of the literature identified two predominant factors related to frequent users in the emergency department: a lack of awareness of medical necessity and issues of access.
Discussion: To address the frequent users in emergency departments, implications for practice need to be explored and implemented. Implications for practice include education of medical necessity for the frequent users, expansion of the pre-hospital role in primary care and inappropriate use prevention, and improvement of access to alternative healthcare services.
The poll of 92 MPs of all parties and regions of the UK also found strong support for a transformation fund for emergency departments with four times as many saying they would support such an initiative as oppose it.
Over 60% of MPs said they would support Emergency Departments (EDs) receiving more money to help with the retention and recruitment of staff.
Despite government claims that the NHS was getting more than the minimum £8bn by 2020 it had asked for, the poll found that only half of Conservative MPs believe that Emergency Departments are currently being adequately resourced.