Accident & Emergency Targets

At first glance the BMA report seems to be being spun by the BBC. I suspect that the report says that 40% of A&E doctors know of a case in their hospital where someone has been discharged inappropriately which is a different thing than saying 40% of A&Es discharge inappropriately.

However I can't comment usefully until the BMA actually publish this report on their website.

UPDATE: It's there now, although unfortunately the full report is only available to BMA members. The main points:

There are 200 A&E Departments in England, the BMA had replies back from 163. Because they talk about Departments, I suspect they sent the questionaire to either the Clinical Director of A&E (if the hospital has one) or the BMA rep for that hospital.

52% of the departments surveyed said that people had been admitted to an inappropriate ward. That doesn't surprise me, it's not dangerous for the patient, but a bed is a bed, and when a suitable bed becomes available then the patient is moved later.

40% said patients had been discharged before they were adequately assessed or stabilised. That's more dangerous, but lets get this in proportion, there are 200 A&Es, around 50,000 attendances each per year, that's 10 million A&E attendances. 80 of those departments have discharged someone early sometime in that year, so that can't be any more than 200 out of the 10 million treated. That's not too bad.

27% reported that care of the seriously ill or injured was compromised because of the pressure to the meet the 4-hour target. This is undefendable, but I would point out that the reason the target is 98% rather than 100% is that there are very valid medical reasons why you wouldn't want to discharge or admit in less than 4 hours. The classic example being someone that's completely drunk, there's nothing wrong with them so they shouldn't be admitted, you shouldn't discharge because they are incapable and it's possible that the drunken stupor could be hiding something more serious, so you let them breach the 4 hour target and just keep an eye on them.

I've just heard Vincent Cable (Lib Dem, Treasury) criticise the Government for setting targets for political reasons. Of course it's political, that's what governments are there for. These targets are not easy, they require extra resources which are going into A&E departments, but both the Tories and Lib Dems are in effect saying that they want to turn the clock back to the old days when waiting 8 hours with a broken wrist was nothing unusual.