Crowding kills

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The Royal College of Emergency Medicine is calling for Trusts to increase short-term Emergency Department capacity in an attempt to mitigate the potentially disastrous effects of overcrowding. Its new report 'Crowding and its Consequences' has found that at least 4,519 patients have died as a result of crowding and 12-hour stays in Emergency Departments in England in 2020-2021.

The report investigates the extent of harm that crowding causes and applies NHSE’s own findings from the Getting It Right First Time (GIRFT) programme which found that one in 67 patients staying in the Emergency Department for 12 hours come to excess harm.

Dr Adrian Boyle, Vice President (Policy) of the Royal College of Emergency Medicine, says: “Quite simply, crowding kills. For many years we have issued warnings about the harm that dangerous crowding causes, but now we can see the number of excess deaths that have occurred as a result. This will not surprise any member or fellow of the Royal College.

“October 2021 saw an unimaginable 7,059 12-hour stays from decision to admit, the highest number ever recorded, 40% higher than September 2021 which was the previous highest on record. The number of 12-hour stays has risen drastically for six months and is very likely to rise again in coming months. The picture is more bleak as Hospital Episodic Statistics show that 12-hour stays from time of arrival are 21 times higher than 12-hour DTA stays. We now know that at least one in 67 of these patients are coming to avoidable harm. It is appalling.

“The situation is unacceptable, unsustainable and unsafe for patients and staff. Political and health leaders must realise that if performance continues to fall this winter: more and more patients will come to avoidable harm in the Emergency Department; staff will face moral injury; and the urgent and emergency care system will be deep into the worst crisis it has faced. This potential trajectory is supported by the recent report by the Association of Ambulance Chief Executives that found that as many as 160,000 patients annually, may be coming to harm as a result of delayed ambulance handovers. We continue to urge the Secretary of State to meet with us to discuss patient safety and the unprecedented pressures facing the urgent and emergency care system.

RCEM CARES: The Next Phase outlines our system-wide plan to improve patient care. In the short-term Trusts must safely expand capacity where possible. They must maximise the use of services such as Same Day Emergency Care and Discharge to Assess. Trusts must focus on promoting flow through the hospital, ensuring patients are discharged in a timely way once their treatment is complete.

“In the long-term, the government must restore bed capacity to pre-pandemic levels - across the UK an additional 7,170 beds are required. The government must ensure that social care is resourced to support patients both when leaving hospital and once they are back in the community, this would help to reduce long hospital stays and prevent successive trips to the Emergency Department.

“Lastly, as a matter of urgency the government must publish a long-term workforce plan, this must include actions to retain existing staff who are reaching burnout as well as to recruit new staff. Across the UK there is currently a shortfall of 2,000 - 2,500 WTE Emergency Medicine consultants, as well as shortages of essential Emergency Medicine nurses and junior and supporting staff.

“This is the beginning of a long winter and an extremely challenging time for the current workforce as pressures will rise and patient safety will continue to be put at risk. These pressures may currently be facing urgent and emergency care and the ambulance services, but the solutions and actions must be system-wide and joined-up. It is up to the government, NHS leaders, and all of us to work together to put a stop to dangerous crowding; avoidable harm; preventable deaths; ambulance handover harm; and to ensure that we keep patients safe and deliver effective urgent and emergency care.” 

 

The report also provides comprehensive analysis on a variety of data points:

• Four-hour target

• 12-hour waits

• Decision-to-admit (DTA) waits and admissions

• 12-hour DTA waits vs 12-hour time-of-arrival waits

• Time to initial assessment for ambulance arrivals

• Time to treatment

• Median total time patients spend in Emergency Departments

• Ambulance handover delays

• Bed availability

• Length of hospital stays.



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