Journal of the Royal Society of Medicine
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This paper examines some of the misapprehensions that have often underpinned the planning of accident and emergency services in the UK. Accident and emergency (A&E) is not a homogenous group of activities and the different components that make up the service should be planned separately. This planning needs to be accompanied by some significant redesign to meet growing patient expectations. In particular, there is a major challenge for services to offer local access in an environment in which acute care is increasingly centralized.
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The Clinical Standards Advisory Group report on urgent and emergency admissions to hospital identified several important issues regarding emergency care. This paper examines what we know about the costs of a quality emergency service. ⋯ It must, however, be recognized that such work by itself will not automatically lead to increased funding within emergency care. Further consideration must be given to the funding arrangements for emergency care if long-term improvements are to be secured.
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Gross underfunding of the National Health Service in England and Wales results in too few beds and operating theatres and too few nurses and doctors. Thus, standards of surgical care, particularly for emergencies, are compromised. ⋯ For general surgery and trauma and orthopaedics this equates to 1 consultant for 30,000 population. Emergency surgical services require the presence on site of all the core specialties, including sufficient fully staffed intensive-care, high-dependency and coronary care beds to ensure their availability for emergency admissions together with 24-hour-staffed dedicated emergency operating theatres.
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The primary objectives of the emergency services are to minimize early mortality and complications, although longer-term morbidity, quality of life and late mortality may also be influenced by early actions. Evaluation of the emergency services and demonstration of quality need to reflect these objectives by appropriate choice of outcome measures. ⋯ The review also discusses capacity, a necessary requirement for a quality service, and operations research/queuing theory to facilitate management of capacity/resources to meet fluctuating demands. The NHS should be able to plan for seasonal needs.