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Watchdog drafts plan to tackle UK’s overcrowded A&E departments Watchdog drafts plan to tackle UK’s overcrowded A&E departments
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Patients should be moved out of busy A&E units when they become so overcrowded or so short of nurses that their safety is in danger, the government’s health advisers will urge hospitals. The recommendation is contained in advice from the National Institute for Health and Care Excellence (Nice) on how the NHS can ensure that A&E departments always have enough nurses on duty.Patients should be moved out of busy A&E units when they become so overcrowded or so short of nurses that their safety is in danger, the government’s health advisers will urge hospitals. The recommendation is contained in advice from the National Institute for Health and Care Excellence (Nice) on how the NHS can ensure that A&E departments always have enough nurses on duty.
A surge in the number of patients turning up at A&E should also prompt hospitals to put in place emergency measures, including bringing in extra staff from other wards, it says.A surge in the number of patients turning up at A&E should also prompt hospitals to put in place emergency measures, including bringing in extra staff from other wards, it says.
In its draft guidance Nice tells hospitals that they should develop “escalation plans to address risk to patient care posed by: variation in demand for A&E services, variation in nursing needs, and departmental overcrowding”. Those contingency plans could include “moving patients out of the A&E department to an appropriate alternative location [and] sourcing extra staff (for example, using an on-call system)”, according to Nice’s advice, published on Friday.In its draft guidance Nice tells hospitals that they should develop “escalation plans to address risk to patient care posed by: variation in demand for A&E services, variation in nursing needs, and departmental overcrowding”. Those contingency plans could include “moving patients out of the A&E department to an appropriate alternative location [and] sourcing extra staff (for example, using an on-call system)”, according to Nice’s advice, published on Friday.
It does not specify what other types of ward or department A&E patients could be taken to, but some hospitals already operate overflow wards near their A&E.It does not specify what other types of ward or department A&E patients could be taken to, but some hospitals already operate overflow wards near their A&E.
Hospitals are also told to ensure that escalation plans mean that they can “make the A&E department safe if departmental crowding cannot be resolved [and] respond to deficits in A&E nursing staff without compromising patient care in other parts of the hospital”.Hospitals are also told to ensure that escalation plans mean that they can “make the A&E department safe if departmental crowding cannot be resolved [and] respond to deficits in A&E nursing staff without compromising patient care in other parts of the hospital”.
Nice’s advice is likely to result in hospitals increasing the number of nurses on duty in A&E more than they already have since Robert Francis QC’s report in February 2013 into the 2005-09 Mid Staffordshire hospital scandal.Nice’s advice is likely to result in hospitals increasing the number of nurses on duty in A&E more than they already have since Robert Francis QC’s report in February 2013 into the 2005-09 Mid Staffordshire hospital scandal.
The watchdog also set out the minimum number of nurses it believes are needed to look after certain types of patient. For example, there should be one registered nurse for each cubicle in triage, one for every four cubicles containing patients with minor or more serious illnesses, and one for every two cubicles in the resuscitation area. Even more nurses are needed to ensure that the most unwell patients receive safe, high-quality care, Nice adds. It recommends that two registered nurses should be on duty to look after every patient who has suffered a major trauma or a cardiac arrest and that one nurse look after every patient who has arrived as a “priority ambulance call”.The watchdog also set out the minimum number of nurses it believes are needed to look after certain types of patient. For example, there should be one registered nurse for each cubicle in triage, one for every four cubicles containing patients with minor or more serious illnesses, and one for every two cubicles in the resuscitation area. Even more nurses are needed to ensure that the most unwell patients receive safe, high-quality care, Nice adds. It recommends that two registered nurses should be on duty to look after every patient who has suffered a major trauma or a cardiac arrest and that one nurse look after every patient who has arrived as a “priority ambulance call”.
A&E units in England are coming under unprecedented pressure stemming from rising demand driven by the ageing population and people with long-term conditions. Earlier this month A&E units recorded their worst ever performance against the target of treating 95% of patients within four hours.A&E units in England are coming under unprecedented pressure stemming from rising demand driven by the ageing population and people with long-term conditions. Earlier this month A&E units recorded their worst ever performance against the target of treating 95% of patients within four hours.
In a note to colleagues passed to a local newspaper earlier this week, a senior hospital nurse at Cardiff University Hospital said that the pressures of working in A&E were worse than when she had worked in Iraq during the second war there.In a note to colleagues passed to a local newspaper earlier this week, a senior hospital nurse at Cardiff University Hospital said that the pressures of working in A&E were worse than when she had worked in Iraq during the second war there.
Questions are already being asked about how hospitals will manage to hire more A&E nurses given that many are already having trouble recruiting and retaining as many as they need at a time of growing demand for A&E care. Dr Peter Carter, chief executive of the Royal College of Nursing, warned that an existing chronic lack of A&E nurses could take years to resolve. “Staff-to-patient ratios are important, but we may be years away from having a permanent solution to this problem, even if the level of demand stays the same. If it rises further, this will be even more difficult,” he said.Questions are already being asked about how hospitals will manage to hire more A&E nurses given that many are already having trouble recruiting and retaining as many as they need at a time of growing demand for A&E care. Dr Peter Carter, chief executive of the Royal College of Nursing, warned that an existing chronic lack of A&E nurses could take years to resolve. “Staff-to-patient ratios are important, but we may be years away from having a permanent solution to this problem, even if the level of demand stays the same. If it rises further, this will be even more difficult,” he said.
Andy Burnham, the shadow health secretary, said: “This clear guidance is welcome, but many hospitals are nowhere near this level. The government needs to set out how it will meet this plan.”Andy Burnham, the shadow health secretary, said: “This clear guidance is welcome, but many hospitals are nowhere near this level. The government needs to set out how it will meet this plan.”