Emergency department pressures need to be tackled through integrated urgent and emergency care

Reference:  BMJ 2015;350:h322

If, as the saying goes, a picture paints a thousand words, then the photograph of a tent being erected outside Great Western Hospital in Swindon to care for patients spilling over from the emergency department spoke volumes. The similarities with battlefield medicine were both obvious and appropriate at a time when hard pressed staff must feel they are in a war zone.

The failure of the NHS in England to meet the four hour target for treatment in emergency departments, and for performance on this indicator in the last three months of 2014 to have fallen to its lowest level since 2003, is worrying for patients and for politicians. Although more than 90 per cent of patients overall, and more than 80 per cent of patients in major emergency departments, were still seen and treated within four hours, pressures at the front door of hospitals signify a health and social care system near breaking point.

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