Addressing Systemic Obstructions in A&E Services for Improved Patient Care

Emergency departments, often called Accident and Emergency (A&E) services, serve as critical access points for urgent medical care. Yet, many A&E departments face persistent systemic obstructions that hinder their ability to deliver timely and effective treatment. These challenges affect patient outcomes, staff morale, and overall healthcare efficiency. Understanding and addressing these barriers is essential to improving patient care and ensuring that emergency services fulfill their vital role.

Crowded emergency department with patients waiting, highlighting systemic challenges

Our recent experience highlights just one issue that contributes to the A&E crisis, adversely affect patient care, diverting and wasting valuable resources within and between departments.

Case Study: Reducing A&E Waiting Times in a UK Hospital

My partner was unwell over the new year holiday period.  As someone with long term health issues we witnessed (not for the first time), the waste of resources that block part of the A&E process.

He has long term health issues.  He has monthly chemotherapy and is therefore seen by the Haematology team at our local hospital monthly.  On attending his specialist cancer clinic on the 30^th December his next cycle of chemotherapy was postponed as he had developed a chesty cough. The department took swabs and he was prescribed an antibiotic.  Over the next couple of days he deteriorated necessitating a call to the 24 hours cancer triage service in the night, which recommended taking him into A&E.  

He had a temperature of 38.6C, outside it was below freezing, a nine mile journey to our nearest hospital and he was not well enough to endure a lengthy wait at A&E. In the morning, I called 111 who sent a doctor out to see him in the late afternoon.  The results of his hospital swab test had revealed that he had ‘flu and due to his compromised immune status, the doctor prescribed Tamiflu.  His ‘flu symptoms started to improve in a couple of days, but his chest symptoms did not.

In the meantime, one of the senior nurses from his cancer clinic called to say they thought he should admitted but they did not have the authority to do this.  It could only be done through A&E.  On that day, he was still not well enough to tolerate a wait of several hours in A&E.

On the 4^th January, I contacted 111 again, saying that he was now well enough to go in to be seen by the out of hours GP service.  This is located on the hospital premises.  The GP carried out a thorough examination and said that he needed a chest X ray, blood analysis, a further course of antibiotics and an extended period taking Tamiflu.  She called through to the medical services unit while we were there as she did not have authority to arrange an X ray or bloods and he would have to go through A&E to access these.  She also sent her notes and recommendations through to the medical services department electronically.

Despite this, his wait in A&E was several hours during which time he was seen by a triage nurse, two other nurses and then a duty (GP) doctor.  Eventually he was given a second course of antibiotic and sent home.

The reason for providing details of this course of events is to highlight the waste of time and NHS resources that results from a system that does not permit GP’s or departments within the same hospital to authorise tests. 

He had been examined by a doctor at the cancer clinic on the 30^th December. The GP at the out of hours service on the 4^th January had already examined him and made recommendations on the day.   A “system” that requires all patients to pass through A&E before accessing other hospital services creates a traffic jam of patients in an already congested service.  Changing this part of the system so that GP’s and hospital departments can arrange tests, could reduce the burden on A&E.

We made every attempt not to block up A&E.  Despite this the time and expertise of at least four doctors, three nurses and several hours adding to the queue in A&E were involved to appease the rigours of the “system”.

This system also has no regard for the welfare of patients.  A&E waiting spaces are the worst possible environment for cancer patients with a compromised immune system.  Sometimes (as on the night of the 31^st December) the patient is simply not well enough to bear A&E process (on previous occasions he has endured 12 hour and overnight waits). 

From my work as a psychologist, I know that situations of hopelessness and helplessness render even healthy people more susceptible to illness and delay recovery in those who are sick.  We are repeatedly told to help/save the NHS.  I have enormous admiration and gratitude for all doctors and health professionals who work within it but this “system”  is simply not fit for purpose.  There needs to be an urgent review of how GP’s and departments can authorise tests without having to funnel all patients through A&E.