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This week we failed spectacularly to achieve 85 per cent on our four-hour throughput target. This was due to bed closures upstream with norovirus induced diarrhoea and vomiting, a bank holiday when support staff in the community couldn’t accept new referrals and a return of winter weather with the corresponding upsurge in elderly patients.
However, less widely reported was the fact that a child who was categorised as a near drowning was successfully resuscitated, as were three victims of inner-city violence, several drug overdoses and eleven acute cardiac events along with a sprinkling of strokes and elderly hip fractures.
I am one of those who believe that although the four-hour target has been useful in focusing on whole patient journeys and improvement in co-operation between departments, the time has come to move on. I agree we should have targets, but having one target for the wide range of our patients makes little sense.
Those with critical conditions need urgent attention and for them a four-hour target is irrelevant: For those who come back week after week, cluttering the department with inappropriate and unnecessary presentations a four-hour target is entirely inappropriate, resulting in a distortion of priorities and an unnecessary pressure on staff.
I know that we perform well on ‘door to needle’ times for lysis and in fracture care and the other more meaningful measures of quality of care so we have nothing to hide. It’s also true that our staff would like something positive said about their efforts instead of the monthly media negativity about target failure, as if this is their fault and has nothing to do with capacity versus demand, bed availability or the lack of community care packages for the elderly.
None of these issues is likely to improve unless Boris’s red bus comes good, clearly a forlorn hope; which means that there is no realistic prospect that we will ever achieve the impossible or that the various health correspondents with their look-up tables of local performance, graphs of failure and simplistic interviews with someone from somewhere who has introduced some ‘new’ variant of triage which has miraculously turned their service around.
Maybe if the camera lingered a little bit longer it would discover patients stacked up in a cupboard labelled ‘assessment’ who will be there all night but whose emergency department computer journey has now successfully completed at 3 hours 59 minutes.
People who need to be in a bed shouldn’t be lying around in the emergency department corridor and if having a four-hour target leads trusts to employ a bed manager to bully and harass those who can assist, then that’s good.
However, I don’t actually care if someone with nothing wrong sits for four, ten or 24 hours in the waiting room - next time perhaps they’ll choose more appropriately and stay at home. So instead of one target we should have several to choose from based on the principles of patient need and quality of care.
Charles Lamb is a consultant in emergency medicine. He writes under a pseudonym
thanks for the article, that was so useful for me. hope you will share more useful content in the future! www.bma.org.uk/.../missing-the-target-or-missing-the-point
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