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Removing four-hour target will have ‘catastrophic impact on patient safety’, A&E doctors warn


By Valeria Fiore
Reporter
31 January 2019

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Scrapping the A&E four-hour waiting time target will have a ‘near catastrophic impact on patient safety’, leading A&E doctors have warned.

The Royal College of Emergency Medicine (RCEM) said that although A&E departments have failed to meet the four-hour target since 2015, scrapping it will have negative consequences on patients’ care.

The comments came after NHS chief executive Simon Stevens told the Health and Social Care Committee on 28 January that they are considering making the standard more clinically relevant rather than changing it because hospitals are not meeting it.

Changes in practice

Changes in medicine practice in relation to sepsis, stroke and heart attacks mean ‘the golden hour requires an early clinical focus on those rather than an averaging out across a four hour experience for a whole variety of patients’, according to NHS England Medical Director Stephen Powis, Mr Stevens said.

More patients will have access to same day emergency care, as stated in the long term plan, with the model to be embedded through 2019/20.

This will reduce the need for them to be hospitalised, meaning the ‘3 hours 59 minutes [target] is not a clinically relevant bifurcation point to decide whether or not they need to be admitted’, Mr Stevens said.

Not consulted

RCEM said the body had not been consulted on what they refer to as ‘a fundamental change to the practice of emergency medicine’.

They are now waiting for urgent clarification from NHS England and NHS Improvement ‘on their position’ and for them to describe the ‘likely unintended consequences of such a poorly thought out strategic policy shift’.

RCEM President Dr Taj Hassan said: ‘This is far from being in the best interest of patients and will only serve to bury problems in a health service that will be severely tested by yet another optimistic reconfiguration.’

The four hour standard was first introduced 2004 and A&E departments managed to meet it until 2013/14, according to a RCEM briefing paper.

However, it later became more difficult to meet the target due to ‘increasingly elderly and complex case demographics, restrictions on social care services, inadequate staffing levels and insufficient acute bed provision’, RCEM said.

RCEM lay group chair Derek Prentice also wrote an open letter to Mr Stevens asking him to clarify who the ‘top doctors’ wanting the target scrapped are.

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