A&E performance - Four Hour Emergency Access Standard: Expert Working Group recommendations report

3. Key Findings

9. The current national Accident and Emergency service definition only covers unplanned attendances and does not accurately describe the facilities available or represent the totality of presentations seen.

10. There is potential inequity for those attending A&E on a planned basis who are not currently subject to the Four Hour Target. These patients are triaged and cared for in the same environment as those self-presenting to A&E. NHS Boards will aim to see patients as close to their appointment time as possible but experimental analysis completed by PHS indicates that these patients can often experience a delay. Additionally there remains inconsistencies across Health Boards in the recording of these patients which impacts on the ability to publish official statistics. Clearer national guidance would support Health Boards to report more accurately. It is recognised that there are also local IT/system challenges that affect consistency with some boards requiring an upgrade to TRAK to allow the new code to be added.

11. There is not an agreed national definition of Ambulatory Emergency Care (AEC, also termed Same Day Emergency Care (SDEC)) and how this activity should be recorded. These services are for people who would otherwise be admitted to hospital but under this model can be rapidly assessed, diagnosed and treated without being admitted to a ward. It may not be appropriate for these services to be on the EAS as patients will have already been assessed and typically have a longer length of stay. This is also true of assessment units.

12. National data on time spent in Acute Assessment Units is not currently captured limiting the ability to measure quality of care.

13. The current references to Acute Assessment Units in A&E recording guidance do not reflect the facilities available. The requirements around furniture causes ambiguity and inconsistencies in the way data is recorded. It is not possible to identify through the national A&E data, submitted to PHS, those who are on trolleys. A clearer definition which describes the facilities available and focuses on referral routes and assessment rather than furniture would support progress in these areas.