Calendar An icon of a desk calendar. Cancel An icon of a circle with a diagonal line across. Caret An icon of a block arrow pointing to the right. Email An icon of a paper envelope. Facebook An icon of the Facebook "f" mark. Google An icon of the Google "G" mark. Linked In An icon of the Linked In "in" mark. Logout An icon representing logout. Profile An icon that resembles human head and shoulders. Telephone An icon of a traditional telephone receiver. Tick An icon of a tick mark. Is Public An icon of a human eye and eyelashes. Is Not Public An icon of a human eye and eyelashes with a diagonal line through it. Pause Icon A two-lined pause icon for stopping interactions. Quote Mark A opening quote mark. Quote Mark A closing quote mark. Arrow An icon of an arrow. Folder An icon of a paper folder. Breaking An icon of an exclamation mark on a circular background. Camera An icon of a digital camera. Caret An icon of a caret arrow. Clock An icon of a clock face. Close An icon of the an X shape. Close Icon An icon used to represent where to interact to collapse or dismiss a component Comment An icon of a speech bubble. Comments An icon of a speech bubble, denoting user comments. Ellipsis An icon of 3 horizontal dots. Envelope An icon of a paper envelope. Facebook An icon of a facebook f logo. Camera An icon of a digital camera. Home An icon of a house. Instagram An icon of the Instagram logo. LinkedIn An icon of the LinkedIn logo. Magnifying Glass An icon of a magnifying glass. Search Icon A magnifying glass icon that is used to represent the function of searching. Menu An icon of 3 horizontal lines. Hamburger Menu Icon An icon used to represent a collapsed menu. Next An icon of an arrow pointing to the right. Notice An explanation mark centred inside a circle. Previous An icon of an arrow pointing to the left. Rating An icon of a star. Tag An icon of a tag. Twitter An icon of the Twitter logo. Video Camera An icon of a video camera shape. Speech Bubble Icon A icon displaying a speech bubble WhatsApp An icon of the WhatsApp logo. Information An icon of an information logo. Plus A mathematical 'plus' symbol. Duration An icon indicating Time. Success Tick An icon of a green tick. Success Tick Timeout An icon of a greyed out success tick. Loading Spinner An icon of a loading spinner.

3 reasons why A&E is so busy: Behind the scenes of Fife’s emergency department

Dr Melvin Carew, consultant in emergency medicine. Steve Brown / DC Thomson
Dr Melvin Carew, consultant in emergency medicine. Steve Brown / DC Thomson

Waiting times at A&E departments across the country have been a hot topic for months.

But what is the story behind those figures?

We visited Victoria Hospital in Kirkcaldy’s A&E department to find out.

And asked director of acute services Claire Dobson and emergency consultant Dr Melvin Carew if difficulties getting a GP appointment increase pressure on A&E.

A&E reception at Victoria Hospital.

Emergency departments deal with a range of injuries and severity of illnesses.

They operate almost like their own hospital within a hospital – people arrive (by their own volition or often by ambulance), are triaged, prioritised according to need and treated.

And the team caring for them includes reception staff, to nurses, nurse practitioners, doctors, consultants and paramedics.

What is the four-hour standard?

Public Health Scotland publish waiting times for accident and emergency departments across the country on a weekly basis.

The Scottish Government has a standard that 95% of patients should be seen within four hours.

The Scottish Government set targets for waiting times.

NHS Fife were regularly between 90 to 97% before Covid, with performance tending to dip over winter when demand was at its peak.

But it has failed to reach target since September 2020, which has led to criticism.

Nationally, the target hasn’t been hit since July 2020.

Why is the target being missed?

There are a number of different factors, but three main issues staff and NHS bosses are dealing with:

1. Higher attendance numbers

Claire Dobson says: “We used to be able to predict when it would be busy, for example after a bank holiday.

“But now it’s just busy all the time.”

Director of acute services, Claire Dobson.  Steve Brown / DC Thomson.

Claire cites the example of Easter time – when attendance numbers were higher than the peak of winter.

Between May and August last year, the Emergency Department recorded five of its six highest daily attendances since records began.

Dr Carew explains: “We can get surges of people coming in – 20 one hour, 15 the next, then 20 the next!

“This is one of the challenges and it can be quite difficult for the team.”

2. Blocks and pressures in the system

The knock-on effect of delays elsewhere in the healthcare system can also affect the flow – especially out – of A&E too, Claire adds.

And because the emergency department doesn’t operate in isolation, sometimes patients have to wait for assessments, transfers and care packages.

The knock-on effect of  delays elsewhere in the NHS can disrupt ‘flow’ of A&E services.

“There’s a relationship with what’s happening in other parts of the hospital and across the partnership,” she explains.

“If the flow through elsewhere is delayed – for example, if we are waiting for someone getting home so we can admit a patient into that ward – it disrupts the flow.”

Dr Carew explains pressures elsewhere have an impact, but so does severity of cases being dealt with on any particular shift, which can’t be predicted.

“If for example someone is in resus (where they need to be resuscitated) they may need the attention of two or three doctors – that has a knock-on and other people have to sit and wait longer than we would like.”

3. Change to types of patients going to A&E

They’ve also noticed a change in the nature of the issues of patients coming into the emergency department.

It is thought to be the knock-on effect of the pandemic.

Dr Carew explains: “The challenge is that we are seeing very sick people. Patients are far sicker and many are a lot frailer.

Delays can be caused by disruptions elsewhere.

“So someone who, in the past, could have been home sooner maybe will be in hospital for a longer time.”

And when we reach the observations area, where patients stay until they are discharged often waiting for transport or assessment, Dr Carew explains the complex issues they deal with.

Overdose

“We’re seeing a lot more people experiencing mental health issues and things with greater consequences for them.

“During Covid, we noticed there was a massive reduction in those patients.

“But what we are seeing now is more severe. If someone has taken an overdose, for example, they need proper assessments and need a lot more observation.”

What’s being done to help?

Changes were made last year to urgent care provision in Scotland with the launch of the Right Care, Right Place initiative.

It is designed to help people get care whilst reducing the pressure on busy frontline NHS services.

Those with life-threatening conditions should continue to go to A&E or call 999.

Right Care, Right Place.

Claire adds: “Anyone whose condition is not life-threatening should instead call NHS 24 on 111, day or night.

“Making this call helps ensure people are directed to the most appropriate service for them, whilst allowing clinical staff to devote more time to caring for those who need it most.”

Fife GP practice patients fear someone will die amid phone system crisis

Already a subscriber? Sign in

[[title]]

[[text]]

Conversation

[[title_reg]]

Please enter the name you would like to appear on your comments. (It doesn’t have to be your real name - but nothing rude please, we are a polite bunch!) Use a combination of eight or more characters that includes an upper and lower case character, and a number.

By registering with [[site_name]] you agree to our Terms and Conditions and our Privacy Policy

Or sign up with

Facebook Google

[[content_reg_complete]]

[[title_login]]

Or login with

Forgotten your password?

[[title]]