If you follow the news, you may have heard the term “A&E 4-hour waiting time” or “A&E Targets”. As an NHS Hot Topic, a question about the A&E, its state or the waiting times, are quite likely to pop up in your medicine interviews.
In this article you’ll find out what the A&E waiting times are, why the A&E targets are important, why are the A&E waiting times increasing and what to do to reduce them. With that knowledge, you are guaranteed to ace any medicine interview questions about A&E wait times.
The term "A&E Crisis" is usually used in reference to the gradually increasing waiting times in Accident & Emergency Departments across the UK. In 2004 a target was set, stating 98% of A&E patients should be either admitted to the hospital or seen and discharged within 4 hours from their arrival. This was later reduced to 95% in 2010, but the 95% target hasn't been met in England since 2014, and the waiting times for patients have been increasing year on year (you can clearly see the trend in Figure 5 here).
🏥 Comparison: The target was established to measure the performance and safety of A&E departments and to compare individual departments to see which are lagging behind. Suppose a department had significantly longer average waiting times than others in the area (neighbourhoods may have varied medical needs). In that case, more staff could be shifted there to tackle the issue.
😷 Patients' Perspective: Length of waiting is also vital for the patients - some medical problems may worsen if not diagnosed promptly, longer waits before a patient is treated means prolonged suffering and overall waiting decreases patient satisfaction.
👎 Downsides: Nonetheless, the metric alone doesn't provide a comprehensive picture regarding the overall performance of A&E departments or the NHS. It has been widely criticised for distorting clinical priorities and coaxing healthcare professionals to compromise the quality of care to meet the target.
There are several primary reasons for that:
📈 Increased Attendance: In the last decade, the number of people attending the A&E has increased year on year (by over 2% on average).
🛏️ Insufficient Beds: Secondly, a large proportion of A&E patients end up being admitted to the hospital as inpatients, which means they require a hospital bed. In recent years the number of available beds has decreased (among others, due to cuts in funding), meaning patients would have to wait longer in A&E for a bed to become available. This is also related to bed-blocking, a situation when hospital beds are occupied for unnecessarily long times (mainly by older patients) as they are waiting for care elsewhere (such as in care homes) to become available.
🩺 GP Pressures: Furthermore, pressures put on GPs and longer waiting times in primary care encourage some patients to visit A&E departments instead of seeking medical help for problems that could be resolved elsewhere (for instance, with the GP or through a phone consultation).
🧑⚕️ Staff Shortages also lead to increased workload and worsened efficiency.
ℹ️ Poorly Informed Patients: Sometimes patients who are ill don’t know where to seek help*,* which is why the 111 service was introduced a few years ago. It provides a triage system, where patients can call and describe their symptoms. The trained healthcare professional taking the call triages the patient and can offer advice, book an emergency GP appointment or dispatch an ambulance to the patient’s location. This ensures fewer inappropriate presentations to the A&E and therefore reduces pressures on the service.
The most efficient approach would be to tackle the issue at its root.
1. Patient Education: To stop and reverse the increase in the number of patients attending A&E, educational campaigns could be designed to inform the patients when to visit A&E (and when to seek help elsewhere), how to self-manage the less severe common medical problems or to promote the 111 service.
2. GP Pressures: Increasing the capacity of general practice would allow some patients turning to A&E to instead turn to their GP (relieving the pressure off A&Es).
3. Number Of Beds: Increasing the capacity of social care services could diminish bed-blocking and increase the availability of hospital beds.
4. Workload: Additional staff could be recruited, or new technologies could be implemented to facilitate the admissions process and reduce workload.
While it may sound simple on paper, please note that each of those solutions requires a substantial amount of additional funding, which in the past years has been scarce.
🗨️ Explain: Say what you understand by the term “A&E crisis” at the beginning of your answer. If the interviewers have a different definition of this term, they should correct you and therefore help you answer the question more accurately.
🔧 Not Acknowledging How Difficult The Situation Is To Resolve. Make sure to explain that there is no simple solution to this issue, but increased funding would definitely help ease pressures on staff.