| Synopsis: |
Health Service Trusts in Northern Ireland have made considerable progress in reducing the length of time patients spend in accident and emergency (A&E) departments, largely through tackling the causes strategically. This reduction has followed a strongly increased focus, since 2006, by the Department of Health, Social Services and Public Safety on Trusts ensuring that patients spend no more than four hours in A&E. The reduction in waiting times has largely come through improvements in working practices within hospitals and, specifically in A&E departments. For example, the lack of senior clinical decision makers in A&E departments has led to patients being admitted who would not otherwise have been. Having a consultant admission vetting system helps to minimise waiting time and to ensure appropriate care.The bottlenecks A&E departments have faced are often outside their control. In particular, lack of inpatient bed availability is one of the fundamental underlying causes of A&E department waiting. Getting patients home more speedily creates capacity on wards enabling ward staff to actively place patients from A&E.The latest information on discharges shows that Trusts have made substantial headway in the timely discharge of 'non-complex' cases from acute settings. The improvement in discharge rates has been achieved as a result of a more proactive approach to bed management. There are still some risks that need careful management, as high level attention to performance in A&E departments could diminish in the longer term, and could lead to less focus on the timely completion of treatment for patients who could be properly managed in a shorter timescale. |