Delays in patients getting into A&E – the real problem to be tackled

Posted: 09/12/2013

The weekend press reports on the significant delays experienced by patients waiting in ambulances for up to six hours before being able to be accepted into A&E make worrying reading. While these delays highlight the usual issues with pressure on A&E departments, it is the knock-on effects of this that need considering.

If ambulances are waiting to transfer patients into A&E, this increases the burden of responsibility on ambulance staff to make an accurate assessment of the patient’s need for treatment. The downside of this is obviously the risk that the severity of a patient’s condition is not appreciated and/or that they deteriorate while waiting in an ambulance rather than in a fully staffed A&E. However, if those patients are stable and able to wait, is this not evidence that perhaps they should not be at A&E at all?

This side of the story focuses on the pressures on emergency resources and the most worrying aspect of these press reports may be that ambulances and their staff are tied up waiting rather than that some patients have to wait to get into A&E, particularly if some cases could be better managed elsewhere.

Philippa Luscombe, partner in the clinical negligence team at Penningtons Manches LLP, commented: “The incidence of patients waiting in ambulances and suffering harm that we see are, thankfully, few and far between. However, what we are increasingly seeing is the delay in getting ambulance service resources to patients at home – and where those delays have, in some cases, fatal consequences. This story is therefore worrying as it provides an explanation for the problems with ambulance resourcing and is further evidence of the need to radically rethink emergency, out of hours and community care services with better assessment of needs and allocation of resources. The real problem to be addressed is to have an ambulance and staff waiting at a hospital with a non-urgent patient when another patient with a life-threatening condition may urgently need assistance.”

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