Sunday, November 25, 2007

Pathetic British emergency medicine

More than half of trauma patients are not receiving good care, experts say. The National Confidential Enquiry into Patient Outcome and Death looked at the care given to 795 patients, many with head injuries from falls and crashes. It found medical staff in 200 hospitals in England, Wales and Northern Ireland often did not appreciate the severity and displayed little urgency. It said care would improve if services were centred at fewer sites - something which is already government policy.

NCEPOD said many of the problems identified in nearly 60% of patients treated across 200 hospitals were associated with staff being too inexperienced. In particular, they found patients were not always given essential tests such as CT scans or assessed by hospital consultants, especially during the night.

Researchers said most hospitals would only deal with one trauma patient a week and this meant staff did not get the necessary experience to keep skills up to date. They also said about 800 trauma patients each year needed to be transferred to other hospitals - often in an "ad hoc" manner - because of a lack of specialist facilities such as neurological services.

Ambulance crews were also criticised for failing to always unblock airways and alert hospitals of incoming cases. But the researchers said in hospitals which dealt with more than 20 cases a week the care was classed as good. The report said this in itself was a good argument for centralising services in regional centres. This is already a government policy, but it is proving controversial because of the aim of a whole host of other services such as maternity and A&E being centralised as well. Campaigners say such a move would lead to many local hospitals being stripped of key services.

Report author Dr George Findlay said: "The number of patients seen has a direct bearing on the experience and ability of clinicians to manage challenging cases. "It is not possible for all hospitals to have a trauma team on call with the necessary experience, organisation and support structures. "We need to look at how we can organise trauma care on a regional basis."

The Royal College of Surgeons said care urgently needed to improve. A spokesman said: "Our mortality rates are among the worst in the developed world, and yet trauma care remains a low priority for the government. "This a national health service and what we need is a national trauma system."

Health Minister Ben Bradshaw said: "We have argued for some time that it is not the proximity of the nearest A&E that matters to most trauma victims but the care they receive from ambulance and paramedic staff and the quality of care they receive once they arrive at hospital. "Concentrating trauma treatment in specialist centres can arouse opposition from some people concerned about 'downgrading' of their local A&E facilities, but what the opponents often fail to recognise is that lives will be saved and the quality of care improved, as this report makes clear."


Crowding in public hospitals kills people

NSW emergency departments are so overcrowded that the situation is contributing to deaths and will continue to do so until more beds are opened, a leading academic has said. New figures, to be released at an emergency medicine conference next week, show that, nationwide, the number of emergency patients waiting to be seen increased by 32 per cent between June and September. Associate Professor Drew Richardson, from the Australian National University medical school, said yesterday the September 3 snapshot of emergency departments also showed a continuing upward trend in patients waiting for a bed since the last snapshot, on June 18, at the same time of 10am.

The new data backs up concerns of emergency staff that chronic overcrowding is affecting patient care, highlighted by Jana Horska's miscarriage in a toilet at Royal North Shore Hospital two months ago. "I believe that mortality is higher in Australian hospitals than it should be because people are being delayed in the emergency department," said Professor Richardson, chairman of road trauma and emergency medicine at Australian National University. "It's about available beds - there's no other way of looking at it . The assumption I make is that hospital overcrowding is contributing to deaths in the Australian community and that until we decide we're going to work our hospitals on the basis of efficiency rather than utilisation, this will continue to happen."

Most of Sydney's major hospitals operate well above 85 per cent capacity - the recognised safe benchmark - to up to 5 per cent over capacity. Professor Richardson will tell the annual scientific meeting of the Australasian College for Emergency Medicine on Tuesday that emergency departments are frequently grinding to a halt - a trend that has been worsening over the past 10 years - because patients are waiting for beds. He said the September survey of 71 hospitals showed a 6 per cent nationwide increase in the number of emergency patients waiting for a ward bed and a 3 per cent increase in those waiting for more than eight hours, known as access block, since the June survey.

NSW had only a 4 per cent increase in patients waiting due to access block but a 20 per cent increase in patients waiting for treatment. However, he said the figures were significantly skewed downwards because the September snapshot was taken in the APEC week in which NSW hospitals cut back services. "NSW deserves a modicum of praise for being better than they used to be, whereas the other states are not, but nationally we have a huge problem," he said.

Professor Richardson said research published in the international journal Critical Care Medicine in June showed that if a patient spent more than six hours in emergency waiting to go to the intensive care unit, their in-hospital mortality rate was 17.4 per cent, compared with 12.9 per cent if there was no delay. He said similar studies in the ACT and Western Australia, published in the Medical Journal of Australia last year, showed emergency department overcrowding was associated with increased mortality.


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