English emergency care varies widely, commission finds
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《英国医生杂志》
Wide variations in the quality of clinical care in England's 200 emergency units have been identified in a new report from the Healthcare Commission. Although all trusts had met the government's target for the end of 2004—of 90% of patients being admitted or discharged within four hours—the report warns that many trusts are struggling with the government's higher target of no patients spending more than four hours in the department.
"This report suggests serious variations in the quality of care. Monitoring standards of quality must become a core part of the day to day management of these units," said Anna Walker, chief executive of the Healthcare Commission. " departments have overall made great strides in improving services, in particular on waiting times, which are very important to patients. departments now have to go the extra mile if they are to deliver the care that patients need and that means focusing on quality as well as waiting."
Emergency services were reviewed by the Audit Commission in 2001 in a report that highlighted the issue of long waits and showed that they had been getting steadily longer during the preceding four years. The new report sets out the results of a major review of emergency services for 2004-5 by the Healthcare Commission, which took over some of the responsibility of the Audit Commission.
As part of the review the commission looked at the performance of individual units in the treatment of three so called tracer conditions and measured them against standards set by the British Association for Emergency Medicine (BAEM). The three conditions were treatment of children with a broken elbow or wrist, elderly patients with hip fractures, and patients who had taken an overdose of paracetamol.
Many trusts are struggling to meet the four hour target for treating patients in the emergency department
Credit: SHOUT/REX
"The quality of clinical care for the three tracer conditions was found to be very variable and often did not meet the standards set out by the BAEM," says the report.
In the average department, just over half (53%) of children in moderate or severe pain as a result of a fractured elbow or wrist received analgesia within an hour of arrival. Six departments achieved 100% compliance, but in eight (5%) it was below 20%. The association's guidance says they should receive pain relief within 20 minutes of arrival for severe pain, or at triage for moderate pain.
In the average department, 42% of patients with hip fracture were offered or received analgesia within 60 minutes of arrival. Performance varied from 100% of patients in the best department to less than 15% in the worst. The association's guidance says that people should receive relief from severe pain within 20 minutes of arrival or triage.
For patients who have taken an overdose of paracetamol it is important to allow four hours after the overdose before taking a blood test, the association says. Most departments observed this for all or nearly all patients, but seven departments did not allow the full four hours for 25% or more of their patients.
Lord Warner, a health minister, said, " services have been making excellent progress over the last two years."(Roger Dobson)
"This report suggests serious variations in the quality of care. Monitoring standards of quality must become a core part of the day to day management of these units," said Anna Walker, chief executive of the Healthcare Commission. " departments have overall made great strides in improving services, in particular on waiting times, which are very important to patients. departments now have to go the extra mile if they are to deliver the care that patients need and that means focusing on quality as well as waiting."
Emergency services were reviewed by the Audit Commission in 2001 in a report that highlighted the issue of long waits and showed that they had been getting steadily longer during the preceding four years. The new report sets out the results of a major review of emergency services for 2004-5 by the Healthcare Commission, which took over some of the responsibility of the Audit Commission.
As part of the review the commission looked at the performance of individual units in the treatment of three so called tracer conditions and measured them against standards set by the British Association for Emergency Medicine (BAEM). The three conditions were treatment of children with a broken elbow or wrist, elderly patients with hip fractures, and patients who had taken an overdose of paracetamol.
Many trusts are struggling to meet the four hour target for treating patients in the emergency department
Credit: SHOUT/REX
"The quality of clinical care for the three tracer conditions was found to be very variable and often did not meet the standards set out by the BAEM," says the report.
In the average department, just over half (53%) of children in moderate or severe pain as a result of a fractured elbow or wrist received analgesia within an hour of arrival. Six departments achieved 100% compliance, but in eight (5%) it was below 20%. The association's guidance says they should receive pain relief within 20 minutes of arrival for severe pain, or at triage for moderate pain.
In the average department, 42% of patients with hip fracture were offered or received analgesia within 60 minutes of arrival. Performance varied from 100% of patients in the best department to less than 15% in the worst. The association's guidance says that people should receive relief from severe pain within 20 minutes of arrival or triage.
For patients who have taken an overdose of paracetamol it is important to allow four hours after the overdose before taking a blood test, the association says. Most departments observed this for all or nearly all patients, but seven departments did not allow the full four hours for 25% or more of their patients.
Lord Warner, a health minister, said, " services have been making excellent progress over the last two years."(Roger Dobson)