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Defining quality of care is difficult even when considering the outcome from standard surgical procedures.1 Assessing the outcome of medical emergencies has become more complex since recent political interventions have increased the potential for convoluting the patient journey, thus contributing to a degradation of the overall quality of care.
Many emergency patients have already run the gauntlet of NHS Direct and a local Drop-in Centre before arriving in A&E, only to be referred on to the Emergency Assessment Unit (EAU) when the four-hour A&E waiting time target seems likely to be breached. Furthermore, many GP referrals could be avoided if Primary Care spent less time chasing politically generated targets instead of pursuing real medical objectives.
Recently, during two separate Take Days involving a total of 19 hours at work in our EAU, I reviewed 52 patients, of which 27 were discharged. Many of these could have been managed throughout by their GP. A few required urgent referral to other specialties, but in order to comply with regulations either the GP had to re-refer the patient as an outpatient or I had to admit them to hospital. In regard to those patients requiring appropriate admission, many finished up under another consultant, thus delaying their ultimate review for several days.
Today, pass the patient (parcel) seems to be a necessary evil: it generates repetition but not quality. Patients need access to a comprehensive Emergency Service with senior staff available at all phases of the patient journey, not a disjointed collection of staging posts. In our Trust the solution would involve employing more Physicians and building a coordinated Emergency Department. Unfortunately, because health care is driven by managers who lack clinical skills, quantity is encouraged in order to generate income—to the detriment of quality.
Competing interests None declared.