Published: 30/05/2002, Volume II2, No. 5807 Page 6 7

Patients are being 'warehoused' in assessment and observation units because of a lack of beds, according to what is expected to be the last snapshot survey carried out by the Association of Community Health Councils in England and Wales.

The national Casualty Watch survey, which examined 167 accident and emergency units, found one patient waiting 95 hours in A&E. The survey is set to be the last of its kind because of ACHCEW's imminent abolition.

The spot checks carried out at 4.30pm on 20 May showed the 20 longest waits across the country ranged from 28 hours to nearly 48, before a big jump to the wait of 95-and-a-half hours at Aintree Hospital trust, Liverpool.

ACHCEW director Peter Walsh said: 'Of particular concern to CHCs this year was the use to which many hospitals were putting assessment and observation units.

What we are finding is that all too often patients are being warehoused in assessment and observation units until an appropriate bed can be found.Many patients are in these units not because of genuine clinical need, but simply because the hospital can't find anywhere else to put them.'

He said many of these patients should continue to be considered as waiting in A&E.

Aintree Hospitals trust criticised ACHCEW's figures, saying they were 'inaccurate' because 'patients had been admitted to the observation ward', which was 'a fully staffed ward area'.

A&E consultant Edward Kadzombe confirmed that the three patients appearing on the 20 longest waits list would have been admitted to the observation ward 'as the most suitable setting for their clinical needs, regardless of the bed situation'.

But the trust acknowledged it had problems with long A&E waits and was, as a consequence, increasing staffing and expanding its medical assessment unit.

President of the British Association of A&E Medicine, Dr John Heyworth, said 'properly run' observation and assessment units were 'an extremely effective and safe way of managing emergency patients'.

'It means some patients wait more than four hours [the A&E target maximum wait] but It is to their advantage.'

But he cautioned: 'There is the potential for them to be misused.

If they are used as an overspill area because of lack of capacity, then that efficiency is abolished.

I've no doubt many trusts have inadequate capacity to deal with emergency demand, so they are using any trolley or bed available. It is a very unsatisfactory situation.'

Ashford and St Peter's Hospital trust - with three of the five longest waits - also said its highlighted patients were in a 'bedded observation ward area', which 'in line with Department of Health guidance... is not considered to be part of A&E'.

It also suggested that fluctuations in A&E demand meant 'a survey over a longer period of time would be more representative'.

Commenting on the total figures, Mr Walshe said: 'Some of these figures are shocking. For many people, even a one or two hour wait in A&E can seem like an eternity. Waits of over 24 hours are clearly unacceptable.'