Research  from the  National Institute of Health Research presenting the organisational characteristics shared by emergency departments by identifying three factors that are strongly associated with shorter waiting times, Organisational factors that influence waiting times in emergency departments (summary) identifies the following key findings:

• Waiting times are a key performance target for emergency departments, with all hospitals aiming to treat and either admit, discharge or transfer people within four hours of arrival.

• Two significant factors that influence waiting times are the size of the department and the seriousness of cases entering the department.

• Three other important factors which are associated with shorter waiting times are:
  • lower levels of sickness absence among nursing staff
  • lower expenditure on non-pay items (such as medical equipment, clinical investigations and processes)
  • a more participative leadership style by the lead consultant.

• Together these five factors account for more than a third of the variation in average waiting times between emergency departments. However, more research is needed to establish ‘cause and effect’ – i.e. whether these factors are responsible for lower waiting times or vice versa.

• Practitioners cite a range of working practices which they believe improve waiting times, such as more co-operative working within the emergency department and better co-ordination with primary and secondary care services. A participative leadership style may help promote such working practices.

• While waiting times have an impact on patient satisfaction, it is important also to understand and address the other factors that influence quality of patient care.

The Queen’s Nursing Institute have produced ‘On The Ground: Mapping Homeless Healthcare’ a report on nursing care for the Homeless.

Key findings are:

• One in three homeless young people have attempted suicide.

• Mental health problems are eight times more likely if you are homeless.

• Homeless people are four times more likely to use A & E Services.

• If a homeless person is injured it is four times more likely to be because they have been assaulted.

• The life expectancy for those sleeping rough is 42 – down from 47 a decade ago.

More than half of all patients arriving in hospital with severe injuries receive poor care, according to Trauma: Who cares? an investigation from National Confidential Enquiry into Patient Outcome and Death (NCEPOD) which also expresses concern about the care of patients before they even reach hospital. Trauma, or serious physical injury, is a leading cause of death of young people, who may end up in hospital after a road accident or fight. It found medical staff often did not appreciate how severely ill patients were and showed little urgency over care. They also made erroneous clinical decisions. Often the problem lay with inexperienced junior staff left to manage trauma patients admitted at night. A third of patients arriving in A&E did not see a consultant there.

A Self assessment checklist for trusts allows Trusts to check their progress in adopting NCEPOD’s recommendations following the 2007 report ‘Trauma: Who cares?’. This toolkit is for Trust use.

You can check out what the papers said on 21st November 2007 about the report on Fade the Blog.