Long Patient Wait Times at the Accident and Emergency Departments in NHS Hospitals - Research Proposal Example

Long patient wait times at Accident and Emergency departments in NHS Hospitals

Introduction

The provision of healthcare sees the presence of different personalities that offer different services as well as various sections or departments in a typical healthcare institution. In any hospital setup, the accident and emergency department is one of the most critical installations that allow for the optimal running of the hospital’s operations. The section is part of the holistic approach to emergency care. The National Health Service, commonly referred to as the NHS, is publicly funded and has become the oldest as well as the largest single- payer medical system the world over. As a public health provider, the NHS enables millions of UK residents to access affordable care through the public hospitals and medical facilities in the country. In recent years, the number of people visiting Accident and emergency centers in the UK has spiked so much that there is fear that the system may not be in a position to handle all those numbers .

In the emergency department (ED), things could change in a split second and swiftness is of the essence. Patients suffering from all kinds of conditions as well as severity visit the emergency center for treatment. Delays in responding to the needs of patients could have grave consequences for all those involved. A significant number of patients brought to the ED require urgent interventions to save their lives and therefore excessive delays diminish their chances of survival and could even result in death. Also, while they may eventually get care, the time spent waiting may make their conditions worse off and thus lower their chances of making a recovery or responding to the treatment that they get.

Crowding at accident and emergency centers is a global problem that has caught the attention of policymakers all around the world. The consequences of this issue include unreasonable waiting times at hospitals, a marked decrease in the rates of satisfaction among patients, as well as a domino effect on the entire operations of affected hospitals . While it may be a global problem, it nonetheless is subject to regional influences such that it may persist in some areas more than others. Some of the factors identified as causes of the long waiting times at ED centers include an aging population that increasingly requires emergency care, a biting shortage of hospital resources, shortages in staff numbers as well as delays in ancillary services. In many countries, governments have a philosophy of universal access to healthcare that sees it organize itself and channel funds to the public health system. This makes it a public good as opposed to a free market commodity. Public funding of health care may thus influence potential causes of delays including such as the number of beds at public hospitals, staffing, as well as the number of community care facilities available.

Statement of the Problem

In the UK, the NHS hospitals have been facing a crisis where they find their accident and emergency departments overstretched and unable to handle a large number of incoming patients. In 2014, the NHS recorded the worst performance record of the hospitals it funded when dealing with accidents and emergencies. The state of affairs is a serious concern to the various stakeholders in the medical sector who worry that such developments may hamper the ability of hospitals to deliver critical care to the people that need it. Therefore, this paper sets out to study the causes of the slow service turnaround rates for accident and emergency at public hospitals in the UK. It considers factors such as operational, technical, structural, and personnel and how they affect the ability of the hospitals to provide emergency care. By understanding the causes of the delays and mapping out areas likely to experience abnormal delays, it will then be possible for authorities to solve the issue of excessive waiting times at the accident and emergency centers of the country’s hospitals.

Rationale for the Study

In carrying out the study, the researcher seeks to understand the causes of the long waiting times at accident and emergency centers in UK public hospitals. Many people are becoming increasingly concerned because of the slow turnaround times at these facilities that could impact on their ability to attend to those with critical conditions that may be a matter of life and death. The knowledge gathered is therefore highly valuable towards the understanding of this phenomenon.

The provision of health care depends on the ability to have the best possible services and to continuously improve on current practices. The accident and emergency center of a hospital serve as the first place where patients arrive for care, and it is, therefore, important to have the place working in the best way possible. By understanding the operations of the centers, it is possible to make recommendations for improvement of the services offered there. In the case of the delays experienced, finding out the causes will aid in coming up with strategies to cut on the time that patients have to wait before receiving care, leading to enhanced efficiencies for hospitals.

Literature Review

Overview

The Accident and Emergency (A&E) department in a hospital is the section of the hospital that deals with genuine and real life-threatening cases. The A&E is the part of a hospital setup designed for emergency medicine and is usually the primary port of call for most of the patients visiting a health facility. As such, it has a staffing to reflect the various needs that an emergency situation would require including paramedics, nurses, porters, diagnostic radiographers, emergency doctors, among others . These people usually have a lot of training in emergency medicine and procedures tailored to situations that require urgent care.

A typical A&E deals with the most severe conditions, and the design and operationalization of the center are such that it can handle the worst scenarios. People brought in could have conditions such as lack of consciousness, being in a state of confusion and throwing fits or having breathing difficulties, and they would be in a state where their condition deteriorates very fast. Other conditions include severe bleeding that is impossible to stop, severe burns or scalds, or even violent allergic reactions. The flow of patients wheeled into the A& E also tends to increase in the event of a major accident or natural disaster in which a lot of people suffer injuries and require urgent medical attention .

A&E departments treat patients who have suffered a recent injury or have been involved in an accident or developed a sudden illness. As a standard, all emergency centers in all hospitals use a system of ranking patients and their conditions based on the severity of the symptoms they present . This ranking ensures that those in the most critical condition receive medical attention first before while those whose situation is not very severe can wait. In many hospitals, the nurse or the attendant at the A&E may direct a patient elsewhere if they think that their condition does not meet the criteria of an accident or emergency or if they feel the situation may require the attention of a specialist. In some instances, the staff at the A&E may direct patients to the urgent care centers and minor injuries units (MIUs) for the treatment of less severe injuries or conditions .

The NHS is a significant player in the provision of health care and caters for the treatment of millions of patients in England. In the year 2013, 18.3 million people visited A&E departments in the country. Of those, 10.8 million received treatment and were subsequently discharged while 3.8 million of the affected people had to be admitted to the hospitals . The state of A&E departments at NHS hospitals is of growing concern to many stakeholders because many hospitals have been struggling to provide emergency services, resulting in excessively long waiting times at the A&E centers.

In 2004, the NHS set itself a target of having 95 percent of all patients visiting A&E attended to within four hours of their arrival. However, recent years have seen a failure in meeting that target, meaning that the A&E centers perform below the expectations set out by the NHS. In the quarter from October to December 2014, the NHS reported that 92.6 percent of the patients checking in at emergency centers in England received care within four hours . That figure marked the lowest performance since the setting of the 95 per cent target. The figures painted an image of hospitals in the country facing exceptional demand and unprecedented pressures to provide emergency care. What was more shocking from the report is the revelation that ten hospitals reported having had ‘major incidents,' a situation reserved only in the case of major medical emergencies such as air crashes or terrorist attacks. Also, the report noted that 20,000 more patients visited A&E departments then as compared to a year earlier, and cited that as the reason for the unusual delays experienced at the departments. In some instances, ambulances had to wait for up two hours just to get patients in the emergency centers and that meant they could not respond to 999 calls as they ought to under normal circumstances. According to Reddy & Aggarwal (2015), Addenbrooke's Hospital reported the worst performance of all the NHS hospitals, recording only 75 percent performance, a long way off from the 95 percent NHS target.

The aspect of crowding at A&E centers or ED is a phenomenon observed the world over, and different people have varied definitions of this occurrence. For some, it is the inability of the A&E centers to provide optimal care as a result of work overload. Others choose to look at it from the perspective of indicators of quality such as waiting times, treatment times, as well as the actual number of patients that visit the departments while endeavoring to provide the best level of care, service, and safety .

One may say that the role of the ED in a typical hospital setup has undergone a lot of change over the years. The previous years have witnessed a substantial shift in the strategic thinking of the role of the A&E on the part of both the physicians as well as policymakers in the health sector. As such, it has moved from being just a triage where that only sorts patients and before sending them to the relevant parts of the hospital to being a place where the primary business is saving the lives of patients who require urgent and immediate care. The first policy of any ED in this day is to group patients according to the severity of their conditions, with priority given to those in the most critical state . As such, the design of the centers now includes walk- in clinics where ambulatory patients receive care. Also, hospitals have established shock- trauma rooms fitted with the latest state- of- the- art equipment to treat those patients that may be critically injured.

The availability of new medical technologies as well as new treatment methods has transformed emergency medicine from what it used to be before. For example, it is possible to treat strokes and blood clots using special intravenous thrombolysis and perform stent placement in myocardial infarction, as well as having an ultrasound machine at the ED . These interventions are critical in terms of time and require speed when performing. As a result, many A&E centers lay a lot of emphasis on resuscitation as a priority; stabilization, investigation, and overall initial management in the ED. Cost- cutting initiatives have seen most hospitals having a policy of treating conditions that would have previously required admission at the A&E . As such, the medical facilities can treat and discharge patients without having to hospitalize them and thereby saving a lot of costs.

The list of the causes of long delays at A&E departments includes factors such as patient acuity which is a measure of the staffing requirement based on the intensity of the patient’s need for care. Other factors include the shortage of beds at the A&E centers and a corresponding increase in the number of patients frequenting the ED, delays from other services such as laboratory and radiology, and insufficient A&E space. Still, shortages in the number of physicians as well as nurses, delays in consultation, and managed care issues also serve as additional causes of the slow turnaround rates at A&E departments .

While the ED is the place where patients receive primary care, the goal is to stabilize them and conducting preliminary investigations before moving them on to other levels in the hospital. The rate of admitting patients from the A&E depends on factors inside the other departments in the hospital. For example, patients in very critical conditions may require admission to the Intensive Care Unit (ICU), but it is only possible to move them there if there are beds available. Apart from the availability of beds, other factors that determine how fast the patients can move from the ED include the number of nurses available as well as their ratios, the local structure, availability of ancillary services and many other factors . Another notable consideration is the scenario facing many hospitals that have to make a choice between emergency and elective admission. In some instances, patients having surgical procedures on weekdays check themselves in at the weekend, and that diminishes the number of available beds for admission of other patients.

Delays at the emergency centers have a raft of effects on hospitals, patients and the quality of care that the institutions provide. Some of the outcomes could even prove catastrophic. In the medical field, timing is everything. Therefore, delays in attending to patients could have very adverse impacts on the clinical outcomes of the procedures administered. As such, the negative performance implies that it is not possible for A&E centers to fulfill their mandate of stabilizing and disposition and at the same time act as an inpatient ward. The backlog at the department would mean that the performance of the two becomes suboptimal and thus impacts on the outcomes.

Research Questions

• What are the causes of the unusual delays at the various accident and emergency departments at NHS hospitals in England?
• What are the possible remedies to the unusual delays at the emergency departments at NHS hospitals across England?

Research Objectives

Having laid out the groundwork for the study, the researcher identifies the following as the objectives for carrying out the study;

• To investigate the causes of the unusual delays at the various accident and emergency departments at NHS hospitals in England.
• To come up with possible remedies for the problem of the unusual delays at the various accident and emergency departments at NHS hospitals across England

Chapter 3: Methodology

Data Collection

The study will rely on primary data from different people who encounter the A&E department on a daily basis. The key consideration is to get the views from the people who encounter the delays on a first-hand basis and have an unhindered view of things. As such, it is important to have the perspectives of those in the first line of the happenings at the emergency centers and therefore have the feelings of what rely goes on in the center. The interviews are widely qualitative and are therefore meant to gauge the sentiments of the respondents. The views collected will then form the overall picture for and aid in policy formulation and guidance in the future. Having first- hand information is important because it is only then that one can get to assess the true situation on the ground. While interviews form the primary data source, there is a need also to have secondary sources for the study. As such, the researcher will count on publications and previous studies on the subject and related phenomena. The material, in this case, has to be the published research in peer- reviewed journals and is, therefore, a credible source of data for the research.

Data Sampling

The study will utilize a sample of fifty individuals for the study. The composition draws from different hospitals and regions in the country so as to capture a diverse population for the study. As such, the study will employ sampling based on the need to reflect diversity in the country. The type of sampling chosen in this scenario is stratified sampling because it makes it possible to have representatives in every category. The method is superior to random sampling because it reduces the sampling error. The categorization includes the size of the hospitals where the hospitals are divided into small and large facilities. Additionally, the hospitals are divided based on their locations with the study dividing the country into six distinct regions upon which to base the sample strata.

Ethical Considerations

Ethics form a critical consideration in any undertaking, particularly in a research scenario. A collection of data is central to the outcomes of the study and helps form the desired conclusions. In the medical field, the need for ethical considerations becomes even stronger because of the sensitive nature of the information. There are several ethical issues to deal with in this study as follows;

Informed Consent

When collecting information, it is imperative that one obtains the sanction from the subjects involved in the study. Given the nature of the setting from where the information is obtained which is a hospital, the researcher has to get clearance from the hospital authorities. Also, the researcher has to seek permission from each respondent before administering the interview . That way, it will become easier for the respondents to open up and give the required information for the study.

Confidentiality

The researcher should ensure that the information they obtain does not get to unauthorized parties under any circumstances. Preserving the confidentiality of the data collected is only accessible to those who have clearance to do that. As such, the researcher has to make the necessary steps to protect the information and ensure it does not get to any other persons.

Health and Safety

When collecting the information, it is important to ensure that the researcher and all those involved observe the highest standards of safety and are at all times operating in a way that does not compromise their security. When collecting data in the hospital, all parties have to adhere to the institution’s safety policies and not do anything that could endanger them.