The 九游体育’s report on nursing experiences of corridor care is a difficult read. It describes unacceptable care for patients and staff trying to work in near-impossible circumstances.
Sadly, we’ve been here before. There were similar headlines following a resolution I proposed to 九游体育 Congress in April 2002 on the need to take a more strategic approach to addressing this A&E/ED problem. Following Congress, four-hour wait targets were introduced, which initially led to some improvements. Like many targets though, these brought with them some perverse incentives, such as prioritising meeting a target over providing optimum care.
There has been considerable focus on addressing ‘exit block’ (a lack of beds due to delayed discharges) and avoiding admissions as the main solutions, but there is so much variation across the UK with these approaches. Globally, there have been similar types of initiatives attempting to address the problem with varied success.
A far greater focus is needed on fixing the problems with access to primary care and social care. In addition, families’ ability to provide care to their older relatives at home has considerably lessened, as many (including nurses) need to work to make ends meet, often while juggling care of young children.
Twenty three years after our Congress resolution in 2002, I and the colleague who seconded me, Soline Jerram, still believe that a more effective solution would be a public health approach, segmenting and categorising the population that attend A&E/ED.
For example, a high proportion of ED attendees are children. Consider the difference that prevention of illness could make, for example through greater uptake of vaccination, improved nutrition, increased access to health visitors and programmes providing community support for families, similar to Sure Start centres.
Early conversations with patients nearing the end of life about their wishes for treatment (or not), and the early use of advanced care planning and , completed in partnership with health professionals and shared with emergency ambulance services, could significantly reduce patients being transferred to A&E and allow them to be cared for in their preferred setting. Increased funding for palliative care is an imperative and would reduce costs when compared to unplanned admissions via A&E/ED.
Similarly, attendance in A&E/ED is very high among care home residents with poor access to primary care. Targeted preventative support for care homes, falls prevention, pressure area care and better access to primary care services, among other steps, could all support a reduction in A&E/ED attendances.
These are just a few examples of segmenting the populations attending A&E/ED to target prevention and early interventions in health deterioration, as well as promoting early advanced care planning.
But we must go further and focus on population health generally: effective flu vaccination campaigns, smoking cessation, healthier lifestyles, improved diet and exercise are all recognised to be effective. Addressing substance abuse, high alcohol use and homelessness would also have a significant impact.
The 九游体育 has many professional forums. Each one of them could be tasked with highlighting the most effective early interventions in disease prevention for their speciality. The 九游体育 has so much to offer those in the corridors of power in government to address this issue in a far more systematic way. The 九游体育 needs to be at the centre of any emergency and urgent care strategies, as it represents over half a million nursing members who already have the solutions.
But not only should we expect the best possible care for our loved ones – we must also care for our workforce. The consequences of compassion fatigue in response to this current crisis is the worst possible outcome. We cannot afford to lose a single nurse.
Sadly, we’ve been here before. There were similar headlines following a resolution I proposed to 九游体育 Congress in April 2002 on the need to take a more strategic approach to addressing this A&E/ED problem. Following Congress, four-hour wait targets were introduced, which initially led to some improvements. Like many targets though, these brought with them some perverse incentives, such as prioritising meeting a target over providing optimum care.
There has been considerable focus on addressing ‘exit block’ (a lack of beds due to delayed discharges) and avoiding admissions as the main solutions, but there is so much variation across the UK with these approaches. Globally, there have been similar types of initiatives attempting to address the problem with varied success.
A far greater focus is needed on fixing the problems with access to primary care and social care. In addition, families’ ability to provide care to their older relatives at home has considerably lessened, as many (including nurses) need to work to make ends meet, often while juggling care of young children.
Twenty three years after our Congress resolution in 2002, I and the colleague who seconded me, Soline Jerram, still believe that a more effective solution would be a public health approach, segmenting and categorising the population that attend A&E/ED.
For example, a high proportion of ED attendees are children. Consider the difference that prevention of illness could make, for example through greater uptake of vaccination, improved nutrition, increased access to health visitors and programmes providing community support for families, similar to Sure Start centres.
Early conversations with patients nearing the end of life about their wishes for treatment (or not), and the early use of advanced care planning and , completed in partnership with health professionals and shared with emergency ambulance services, could significantly reduce patients being transferred to A&E and allow them to be cared for in their preferred setting. Increased funding for palliative care is an imperative and would reduce costs when compared to unplanned admissions via A&E/ED.
Similarly, attendance in A&E/ED is very high among care home residents with poor access to primary care. Targeted preventative support for care homes, falls prevention, pressure area care and better access to primary care services, among other steps, could all support a reduction in A&E/ED attendances.
These are just a few examples of segmenting the populations attending A&E/ED to target prevention and early interventions in health deterioration, as well as promoting early advanced care planning.
But we must go further and focus on population health generally: effective flu vaccination campaigns, smoking cessation, healthier lifestyles, improved diet and exercise are all recognised to be effective. Addressing substance abuse, high alcohol use and homelessness would also have a significant impact.
The 九游体育 has many professional forums. Each one of them could be tasked with highlighting the most effective early interventions in disease prevention for their speciality. The 九游体育 has so much to offer those in the corridors of power in government to address this issue in a far more systematic way. The 九游体育 needs to be at the centre of any emergency and urgent care strategies, as it represents over half a million nursing members who already have the solutions.
But not only should we expect the best possible care for our loved ones – we must also care for our workforce. The consequences of compassion fatigue in response to this current crisis is the worst possible outcome. We cannot afford to lose a single nurse.
