As accident and emergency departments concentrate on driving down waiting
times, the Healthcare Commission has warned hospital trusts to monitor
variations in the quality of care. The Commission surveyed 200 departments
and found that some patients are not receiving the standard of care that A&E
Some children and older people do not receive pain relief for fractures
promptly enough. Just over half of children in moderate or severe pain as a
result of a fractured elbow or wrist received analgesia within an hour of
arrival. For older patients with hip fractures only 42% received relief with
the hour. There were also failures with patients who had taken an overdose
of paracetamol. Some departments did not allow four hours after the overdose
before taking a blood test.
The Commission gave the departments surveyed the option of re-auditing
services in March 2005. For the 47 departments that resubmitted data the
average percentage of children with wrist and elbow fractures receiving pain
relief within 60 minutes increased from 60% to 70%. The equivalent figure
for recording pain relief scores increased from 10% to 42%.
The Commission also found that the great majority of patients are happy with
the overall standard of care. On average, 71% of patients rated their
overall standard of care as excellent or very good. But this varied between
trusts from 85% of patients to 39%. Data to be published this week will show
that since March 2005, 98% of patients are being treated within four hours.
Patients are increasingly taking advantage of minor injuries units and
walk-in centres for basic emergency treatment. These now handle more than
20% of all emergency attendances.7