Trusts struggling to hit accident and emergency indicators

HSJ has examined trusts’ performance against the A&E indicators implemented last month. HSJ used the most recently published hospital episode statistics data which provide an average for 2010.

One of the eight new indicators states that the median time from a patient’s arrival in the department to treatment by a decision making clinician should be within the Department of Health’s “bottom line” of 60 minutes. But only 39 per cent of trusts hit this in 2010, the analysis shows.

Another indicator requires all patients to be seen within 20 minutes and 95 per cent within 15 minutes. But just over half of trusts achieved an average time to initial assessment of 20 minutes or better.

However, trusts are already performing well against the indicator requiring that no more than 5 per cent of patients leave without receiving treatment. Just 11 per cent of trusts were above this benchmark in 2010.

Trusts will still be expected to see 95 per cent of patients within four hours, as well as keeping the rate of unplanned reattendances at A&E at between 1 and 5 per cent.

College of Emergency Medicine president John Heyworth, who helped develop the indicators, accepted they would place some “extra demand” on the system and that it would take time for trusts to achieve them.

Leeds Teaching Hospitals Trust currently has a median arrival to treatment time of 151 minutes. Clinical director Stephen Bush told HSJ he welcomed the indicators, despite the challenges, and said they would require a change to the “whole system”.

He said: “The four hour standard transformed the emergency department experience for patients. Because the trust had to meet it, there had to be major changes with how departments interacted. It gave us clout and this is a way of carrying that on.”

There are eight indicators in total and from July, foundation trust regulator Monitor will consider intervention if a trust is failing on three or more of them.

Two weeks ago, the Foundation Trust Network called for trusts to be given more time to prepare for the indicators.