Overcrowding in A&E leading to catastrophic consequences

Accident and Emergency departments across the country now routinely have to turn patients away at the door due to overcrowding, often with tragic consequences. The Royal College of Emergency Medicine (RCEM) reported in January that up to 500 patients may have died in 2014 as a direct result of this overcrowding, either due to delays in treatment or being turned away altogether because of bed shortages[i]. New data obtained by the Sunday Times, via a Freedom of Information Request, has shown that some A&E departments have had up to 29 instances of being too busy to admit patients, including those arriving by ambulance[ii].

Although many of these temporary “diverts” are lifted within an hour, the consequences for those turned away can be dire. Ashley Findler, a 31-year-old electrician, interviewed by the Sunday Times, was twice sent home from the A&E department at Royal Stoke University Hospital, despite coughing up blood in the waiting area. Mr Findler was suffering from a pulmonary embolism, a partially collapsed lung and kidney problems. The consultant who eventually saw Mr Findler told him he was lucky to be alive, and he has since been re-admitted to hospital with a serious kidney condition.

Dr Clifford Mann, president of the RCEM told the Sunday Times that the queues building up in A&E departments have caused a situation whereby patients whose condition warrants being admitted to a ward are being treated in A&E cubicles, whilst patients who should be treated in A&E cubicles remain on ambulance trolleys until the cubicles become available.

Dr Mann added that this has led to nurses having to double up as ward nurses whilst also delivering emergency care, which he called “completely unacceptable to both nurse and patient”. This overstretching of nursing staff has predictably led to “burnout” among A&E staff. Statistics published by the Liberal Democrat party have shown the scale of the problem from an NHS staff perspective, as they reveal that there have been over 10,000 complaints about staff shortages since 2012[iii].

The overcrowding appears to be caused by a combination of unprecedented demand and a lack of availability of beds, caused by “bed-blocking”, whereby patients who are clinically ready to be discharged remain in hospital due to there being insufficient social care available for them in the community. These often elderly patients who remain in hospital become vulnerable to hospital-acquired infections and pressure sores, which in turn can lengthen the period of time they have to spend in hospital, even if the requisite social care becomes available in the community.

It is difficult to say how the situation can be improved. Anecdotally we hear of the immense pressure placed on clinicians in A&E by the sheer volume of patients presenting there, particularly at the weekend[iv]. The issue of bed-blocking is an incredibly difficult one for the authorities to address with limited resources. Clearly investment is required in social care, so that patients who are clinically ready to be discharged can actually be discharged and their care continued in the community. Theoretically this would free up their beds and allow patients to be admitted onto wards where appropriate, and this would ease the pressure on staff and allow patients being admitted through A&E to be treated in the appropriate setting. That said, it is questionable whether this is a realistic aim in the current climate of public spending cuts.

Notwithstanding the difficult position that A&E staff are placed in, situations such as that experienced by Mr Findler can have dire consequences. Delays in diagnosis or treatment can lead to significant and unnecessary injury, which can potentially give rise to a claim for clinical negligence, and at Lester Morrill, we specialise in such cases.

If you think you, or someone you know, may have suffered an injury as a result of negligent medical treatment and would like to speak with a member of the clinical negligence team, please call on 0113 245 8549.

The author of this blog is Charles Myers, paralegal in the clinical negligence department.

[i] ‘Overcrowded hospitals ‘killed 500’ last year, claims top A&E doctor’, The Observer, 24 January 2015 (http://www.theguardian.com/uk-news/2015/jan/24/overcrowded-hospitals-deaths)

[ii] ‘Overcrowding at A&E ‘killing thousands’’, The Sunday Times, 5 July 2015 (http://www.thesundaytimes.co.uk/sto/news/uk_news/Health/article1577053.ece)

[iii] ‘NHS staff make ‘staggering’ complaints over shortages’, BBC Online (http://www.bbc.co.uk/news/uk-wales-politics-33477236)

[iv] Surviving a night in A&E: a doctor’s story, The Guardian, (http://www.theguardian.com/society/guardianwitness-blog/2015/jan/08/surviving-night-nhs-hospital-a-and-e-doctors-story)