Hospitals take short term measures to meet targets

Two thirds of accident and emergency (A&E) departments in England put in place temporary measures during a recent monitoring week so that they appeared to meet the government's waiting time target of four hours, a BMA survey has found.

Preliminary results from the first 100 A&E consultants from a total of 500 who were sent a questionnaire showed that more than half (56%) had used temporary medical and nursing agency staff to reduce patient waiting times during the monitoring week. One in four consultants (25%) reported that their departments had allowed staff to work double or extended shifts at this time.

Nearly one in six (14%) survey respondents said that routine surgery had been cancelled to make extra beds available to admit patients arriving through A&E departments.

The survey findings showed the perverse effects that can result from the way in which government targets are measured.

A&E departments were given warning of the Department of Health monitoring exercise to measure waiting times, which took place over one week starting 24 March 2003.

During this week, data were collected to determine whether A&E departments were meeting the NHS plan target of 90% of patients waiting no more than four hours in the department from arrival until admission to a hospital bed or discharge.

The results of the monitoring exercise have not yet been published. However, a newspaper reported from a Department of Health internal document that some hospitals showed 10% increases in the number of patients treated within the four hour target period during the monitoring week (Observer 2003 May 11:1)

Mr John Heyworth, president of the British Association for Accident and Emergency Medicine, warned: “The results of the A&E departments' performance during the measuring period should be interpreted with caution. They were, in many cases, illusory and a reflection of the extraordinary changes driven by hospitals desperate to achieve the government target and fearful of the penalty for failure.”

Mr Don MacKecknie, an A&E consultant at Rochdale Infirmary and chairman of the BMA's A&E committee, agreed: “The performance of A&E departments should be monitored in a meaningful way, that would demonstrate staffing and resources needed to maintain targets over the long term. This should take place throughout the year.

“The majority of A&E departments have computerised systems and send weekly figures to the department of health. There is no reason why these figures should not be used to monitor performance.”

More than half (60%) of the consultants who have responded so far to the BMA survey considered that efforts to meet government targets distorted clinical priorities in A&E departments. The most common concern was that staff tended to deal with minor cases promptly, to minimise their waiting times, with the risk that more seriously ill or traumatised patients were left and so waited longer than usual. Some consultants also had concerns that patients were being rushed through A&E departments or were inappropriately admitted or transferred before being stabilised or adequately assessed.

“The government's obsession with waiting times is nothing more than bean counting. The monitoring exercise should at least demonstrate to the government that what the NHS needs is sustained long term investment in staff and sufficient availability of inpatient beds for emergency admissions, if it wants to see consistently high results,” pointed out Mr MacKecknie. “A&E departments need sustained investment and not quick-fix measures to achieve targets.”

The BMA is planning to publish the full results of the survey in the next few weeks.