BLOG: A&E Crisis and Patient Flow - Why are we waiting?

By David Fillingham, Chief Executive, Advancing Quality Alliance (AQuA)

David Fillingham, Chief Executive

Accident and Emergency Departments are busy places. This winter in particular has been a difficult one for many hospitals, with queues of ambulances forming outside at peak periods and lengthening waits for patients to be treated or admitted to a bed.  Indeed, across England as a whole the performance of Emergency Departments has not struggled so much for over a decade.  The reasons for this are complicated. 

Anyone who has themselves needed emergency care, or has had a relative cared for, will know that it is a highly complex system. GPs, ambulance services, hospitals, community services, care homes, social care, and in particular mental health services, all have a vital part to play.  If the way they work together isn't carefully coordinated, then it’s all too easy for the system to become “blocked”.

Bottlenecks develop so that patients have long waits to see a GP, or to be admitted to hospital, or to be discharged from hospital, or to receive the kind of the care they need to live independently in the community.

The evidence shows that problems in achieving an effective and smooth flow of patients across the whole system can have very damaging consequences. The experience of the patients and staff working in the system can be a poor one.  The outcomes of care are worse, the costs of running the system can be much higher, and in the worst cases there could be even be deaths which could have been avoided.

Work on improving patient flow has tended to focus inside hospitals, and mainly on emergency care, particularly the role of A&E Departments and Admissions Units. AQuA believes that to bring about large and sustainable benefits we need to widen our thinking to consider all aspects of care and how they can be connected together more effectively. 

AQuA is currently carrying out a “scoping review” to identify how we can best support our members to improve whole system patient flow during 2016/17. We are working closely on this with other organisations, such as the Emergency Care Intensive Support Team and the North West Utilisation Management Team, and are also receiving support from the Health Foundation.

We will be looking at the latest evidence base, considering best practice elsewhere, and seeking to identify change principles and interventions that will improve the flow of patients across the whole health and social care system.

We are keen to hear the ideas and suggestions of AQuA members, and in particular to know about any initiatives which are already seeking to address this difficult challenge.

Please do get in touch with your thoughts and comments via aqua@srft.nhs.uk or tweet us @AQuA_NHS.