Saturday, 24 January 2015

Overcrowded hospitals ‘killed 500’ last year, claims top A&E doctor

Ministers warned that the NHS is facing ‘a disaster’ of ever-busier accident and emergency departments and bed-blocking

Some 350 deaths were caused by people not being treated fast enough in overstretched accident and emergency departments, a study says. Photograph: Mike Goldwater /Alamy

Up to 500 patients died last year as a direct result of harm they suffered when hospitals became dangerously overcrowded, Britain’s A&E doctors have warned.
About 350 of the deaths were among patients who had not been diagnosed or given medical treatment quickly enough. Another 150 were not admitted because of bed shortages, even though their condition meant they would usually have been found a place on a ward. The College of Emergency Medicine’s figures have raised concern that growing turmoil in A&E units, and hospitals generally, is doing real harm.
Dr Clifford Mann, the college’s president, said its estimates were based on international studies which show that patients who arrived at emergency departments when hospitals are overcrowded were at greater risk of dying. “It’s sobering that up to 500 patients a year die because too many of our emergency departments are too often overcrowded. It’s a cogent reminder to the people who run the NHS that overcrowded emergency departments are just unacceptable and dangerous,” he said.
A&Es in England were busy about 25% of the time, he added, which meant that 3.5 million patients who turned up at an A&E department each year were at slightly increased risk of death.
Applying the results of studies from Australia and Canada showed that up to 350 A&E patients with a range of serious illnesses, who ended up waiting longer for admission than the supposed NHS maximum of 12 hours, would die, Mann said. Although the exact reason is not clear, delays in diagnosis and vital treatment, such as surgery or antibiotics, are thought to explain most of the deaths.
The remaining 100-150 deaths are among patients who turn up at A&E and would usually be admitted, but are sent home because the hospital has run out of beds. Mann said: “We know that mortality rates for a whole range of conditions are higher when A&E units are overcrowded, compared with when they aren’t. There’s an increase in mortality rates for patients when they are admitted from overcrowded emergency departments. We are talking about a relatively small increased risk, but it’s an absolute risk that we should be concerned about.”
In a November 2013 report on reform of urgent and emergency care services, NHS England accepted that overcrowded A&Es do carry an increased risk. “Crowding in A&E departments is a growing threat to patient safety and can have a significant impact on all patients,” it said.
NHS statistics show that the number of patients waiting between four and 12 hours to be admitted, and the numbers waiting for more than 12 hours, both rose significantly during 2014.
NHS England said: “Unprecedented numbers of patients are accessing services, and staff are dealing with the highest-ever number of 111 and ambulance calls, A&E attendances and emergency admissions.
“Demand is highest in winter as more people suffer from serious illnesses, especially respiratory conditions, and there are as a result more deaths at this time of year. This is why we have worked hard to minimise unnecessary delays in urgent care and prioritise those patients at greatest risk. This has included injecting some £700m into the NHS to help bolster services with an extra 700 doctors, 4,500 nurses and more than 3,000 24-hour GP services, 999, 111, A&E and community and social care services.”
Meanwhile, ministers are being warned that the NHS is facing a “disaster” of ever-increasing bed blocking because social care is “chronically underfunded”. An alliance of local councils, NHS organisations and charities says more beds will be occupied by patients trapped there because the services they need after discharge are falling victim to cuts.
“The health and social care system is chronically underfunded. While this remains the case, care and support for elderly and disabled people will only deteriorate,” they say in a letter in the Observer.

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