Patients ‘admitted inappropriately to beat waiting time targets’

By Ian Quinn

Patients in A&E are frequently admitted to hospital by NHS staff struggling to avoid breaching 'unsustainable' Government waiting time targets, a new study has shown.

A report by Audit Scotland on emergency departments in the country found that increasing use of A&E services, NHS 24 and ambulance services has led to growing number of patients being forced to wait on trolleys, as services struggle to cope.

And more than half of the doctors and nurses surveyed said they were aware of patients being admitted inappropriately to ensure A&E departments avoided breaching the four-hour waiting time target.

GP leaders in Scotland have described the findings 'scandalous' and called for a full investigation.

The Audit Scotland report said: 'Over 55 per cent of staff feel that patients are sometimes inappropriately admitted to hospital to avoid breaching the target.'

‘Almost half of the doctors and nurses surveyed by the body expressed concerns over the sustainability of the four-hour standard.'

Audit Scotland found nearly a quarter of patients attending emergency departments were admitted to a hospital ward or transferred to another hospital for further care, a very similar figure to England.

However, the rate of admission was higher in some hospitals in Scotland. In eight emergency departments, over 30 per cent of patients who attended were then admitted to hospital or transferred to another hospital for further care.

The report also raised concern about patients being sent to A&E inappropriately, with the NHS 24 service perceived by the vast majority of staff to be overcautious in sending patients - an accusation also widely levelled at NHS Direct south of the border.

More than a fifth of patients who self-referred or were referred by 999 emergency services to the emergency department were admitted, while 60 per cent of patients brought in by the ambulance service and 30 per cent of NHS 24's referrals went on to be admitted.

Patients sent in by a GP were most likely to be admitted or transferred (62 per cent), which the report said ‘may suggest that GP referrals are more appropriate'

The report added: ‘There is a perception that NHS 24 is overly cautious and refers some patients unnecessarily to emergency departments. Over three-quarters of staff expressed concerns about referrals received from NHS 24. However, NHS 24 referrals account for less than four per cent of emergency department attendances.'

Dr Brian Keighley, chair of BMA Scotland said: ‘The report confirms that rising demand is not the result of the new GP contract introduced in 2004. The report also highlights that GP referrals to emergency services are appropriate.'

‘Reports that more than half of doctors and nurses surveyed by Audit Scotland believed that patients are sometimes inappropriately admitted to hospital to avoid breaching the four-hour waiting times target is scandalous and I would urge the Government to investigate this matter.'

The report claims it is difficult to compare performance against the four-hour waiting time standard in Scotland with other parts of the UK.

The standard in Wales and Northern Ireland is 95 per cent of patients to be seen within four hours. In England, trolleyed areas of assessment units are not included in the standard but they are included in Scotland.

In the study, over 70 per cent of staff disagreed with the statement that ‘there are no trolley waits in the emergency department'. Dr Keighley said trolley waits could ‘strip patients of their dignity.'