Transforming Emergency Care in Northern Ireland
Health Service Trusts in Northern Ireland have made considerable progress in reducing the length of time patients spend in accident and emergency (A&E) departments, largely through tackling the causes strategically. This reduction has followed a strongly increased focus, since 2006, by the Department of Health, Social Services and Public Safety on Trusts ensuring that patients spend no more than four hours in A&E.
The report to the Assembly by head of the Northern Ireland Audit Office, John Dowdall CB, points out that the reduction in waiting times has largely come through improvements in working practices within hospitals and, specifically in A&E departments. For example, the lack of senior clinical decision makers in A&E departments has led to patients being admitted who would not otherwise have been. Having a consultant admission vetting system helps to minimise waiting time and to ensure appropriate care.
The bottlenecks A&E departments have faced are often outside their control. In particular, lack of inpatient bed availability is one of the fundamental underlying causes of A&E department waiting. Getting patients home more speedily creates capacity on wards enabling ward staff to actively place patients from A&E.
The latest information on discharges shows that Trusts have made substantial headway in the timely discharge of “non-complex” cases from acute settings. The improvement in discharge rates has been achieved as a result of a more proactive approach to bed management. For example, discharge-focussed treatment plans are established for all patients within 24 hours of admission.
Today’s report says there are still some risks that need careful management in order to deliver and sustain the Department’s challenging waiting times targets. For instance, high level attention to performance in A&E departments could diminish in the longer term. Moreover, it could lead to less focus on the timely completion of treatment for patients who could be properly managed in a shorter timescale.