It is coming up to that time of the year when I start to question why I choose emergency medicine as a career. Yes, winter is here and along with it a crisis in most emergency departments around the country. Patients left for long hours in the corridors of an emergency department waiting for a bed. It is possibly the single most inhuman thing we do to our patients in NHS. Somehow we forget the basic decency any human deserves, privacy and dignity. Somehow it seems acceptable to leave a sick human being in the corridor of an emergency department. After all these years in NHS and emergency medicine, this is the one thing I fail to get my head around.
Overcrowding of emergency department does a lot of collateral damage. It leads to poorer care for patients in emergency department because the same number of nurses and doctors are now expected to look after sometimes twice or thrice the capacity of a department. It leads to delay in getting a patient seen by a clinician in a timely manner. Then there is the effect of all this on the morale of the doctors and nurses in emergency medicine. Every winter this issue is raised by everyone in emergency medicine. A sticky plaster is provided to temporarily silence the issue. Roll on another winter and the fundamental issues have still not been dealt with. In addition there is the year on year increment in number of patients with more or less no increase in workforce.
Is it possible to fix this issue or do we just moan about it and then shut up? ED overcrowding is a complex issue with a variety of factors which influence it. Below are some of the main issues.
1-Inadequate primary care access leading to patients not able to see their GP in time to sort out minor ailments and they end up coming to the emergency department. In particular elderly patients in a nursing home who could have their problem sorted in the community by a GP ends up using a lot of resources to make the journey to the emergency department in an ambulance.
2-Annual increase in number of patients visiting the emergency departments with very little increase in number of health care professionals to deal with it.
3-Inadequate provision of minor injury/ailment centres in most areas. This leads to every patient attending the sole emergency department in each area.
4-Lack of adequate number of acute care beds and nursing home/residential home places. This is probably the single biggest factor leading to what is traditionally called exit block.
Even to a casual observer there are immediate solutions available and it does not need a rocket scientist to work it out. However the NHS management is riddled with short term thinking and a reluctance to invest money in the right place to fix this issue. Politicians would play their usual games of appearing to support the NHS, media would intermittently show some interest in the issue, the management of NHS meanwhile will appear to tackle the issues with predominantly short term plans and we will go through all this another year in ever worsening numbers. Meanwhile it is left to the individual doctor and nurse to somehow maintain their sanity in the madness of an overcrowded emergency department whilst trying our best to provide the best care possible.
There is absolutely nothing new in the above the blog which has not already been written about and discussed in various channels. Apologies for that. Somehow just putting it in writing here is cathartic for me and I might just have that little extra energy to go through another winter knowing that nothing will ever change in an overcrowded emergency department.
- a very tired disheartened emergency physician hoping that we put our foot down and say 'A BIG NO TO ANY PATIENT BEING LEFT ON A ED CORRIDOR'. Can we?
