‘Exit blocking’ puts A&E patients at risk

PATIENTS attending crowded A&E departments are being put at risk as hospitals struggle to admit patients to wards, doctors have warned.

Edinburgh Royal Infirmary Accident and Emergeny Department. Picture: Greg Macvean
Edinburgh Royal Infirmary Accident and Emergeny Department. Picture: Greg Macvean

The College of Emergency Medicine (CEM) said as many as 500,000 patients across the UK every year could see their situation deteriorate as a consequence of “exit blocking”.

This occurs when emergency doctors recommend that a patient should be allocated a hospital bed but they are unable to be admitted in a reasonable time frame.

Dr Martin McKechnie, vice chair of CEM Scotland, said “exit block” was seen on a daily basis in A&Es in Scotland, despite efforts to increase staffing in emergency medicine in recent years.

He said that international studies had shown that for every 50,000 attendances in A&E, crowding will contribute to 13 deaths due to delays in getting appropriate treatment or assessment.

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“The current government in Scotland have engaged with us over the last two to three years with respect to the speciality and quality of the service, but we haven’t had any change to the demand made on that service, other than that demand continues to rise,” Dr McKechnie said.

“The complexity of what presents is continuing to rise because the population is getting older and has lots of illnesses going on.”

The college, which speaks on behalf of doctors and consultants working in A&E departments in the UK, warned that patients can suffer as a result of crowded emergency departments.

“Crowding, where an emergency department becomes gridlocked, occurs in all emergency departments from time to time. Crowding is associated with increased mortality,” according to guidance issued by the body to hospitals.

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CEM president Dr Clifford Mann said: “We are concerned with patient safety. When the A&E becomes crowded because of exit block we know that patients do less well.

“This is such an important issue. It is about the flow of patients from ambulances, through A&Es and into hospital wards.

“The simple fact is that crowding kills.

“It is simply not acceptable to let this situation continue which is why we are speaking out to urge hospital chief executives and their boards to make sure they have plans to deal with this issue.”

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The CEM has been warning of the need to try to avert a “crisis” in emergency medicine for some time.

It want to see patients moved on more quickly to wards where they be cared for, rather than waiting on trolleys in A&E.

It has also set out other measures to improve emergency care, such as providing other services where patients can be directed if they do not really need to be seen in A&E.