A&E treatment comes under attack

http://news.bbc.co.uk/go/rss/-/1/hi/health/7038114.stm

Version 0 of 1.

Trainee doctors are not always able to spot very ill patients on arrival at A&E and consultants do not review the cases quickly enough, an inquiry says.

Patients should be seen by a specialist within 12 hours, the independent watchdog NCEPOD said, but in 40% of cases examined this had not happened.

In some of these, the delay impacted upon whether the patient survived.

It also found problems in access to CT machines, with 15% of emergency units not able to offer scans 24 hours a day.

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) looked at some 1,800 of the most seriously ill patients admitted to A&E departments across the country in one week in 2005.

They were people who had either died within the week at hospital or after being discharged, or who had been transferred into critical care.

These patients were thought "most likely to test the processes of care during their hospital stay".

'Poor' assessments

Many were assessed by trainee doctors on arrival and just over 7% had an initial assessment that was deemed to be "poor or unacceptable".

KEY FINDINGS 40% not seen by specialist within 12 hours16% waiting 'unacceptable' length of time15% of units without 24 hour CT scans

Being assessed by a junior doctor could be problematic, the report said, because of the way in which current working time directives limited the amount of time they were spending with patients.

"There is concern that they are less able to recognise the critically ill patients and act decisively. Many examples of this were seen throughout the study," the reports' authors wrote.

In 16% of the cases reviewed, sick people were waiting an "unacceptable" length of time to see a consultant.

One elderly patient waited 17 hours to see a specialist, by which time his condition had so deteriorated that despite aggressive treatment with antibiotics he died 24 hours later.

In 53% of cases it was impossible to tell how long the patient had waited because of "very poor" note taking.

"Recent reports have focussed on the immediate care of patients by the emergency services," said NCEPOD clinical co-ordinator, Dr David Mason.

"We wanted to increase the insight into the organisation and ongoing care of emergency admissions."

Recommendations included making sure trainee doctors could recognise critically ill patients, but also ensuring that initial assessments of patients admitted as emergencies are carried out by an experienced doctor.

A Department of Health spokesperson said it expected the NHS to ensure everyone had access to specialist opinion "where appropriate".

"Overall, patients tell us that their experience in A&E has improved - eight out of 10 people say that they had a good experience in the latest Healthcare Commission survey.

"However, there is no room for complacency and the NHS needs to ensure that it delivers high quality and appropriate care to patients at all times."