A&E plan to divert patients ‘risks lives’
NHS officials have ordered a national review into schemes to send patients away from Accident & Emergency departments, amid fears that desperately ill people are being put at risk.
Every NHS trust is under instructions to introduce “front-door streaming” by this autumn, with GPS stationed at casualty units to weed out the least sick patients. The initiative is part of attempts to reduce hospital overcrowding and record-level waiting times.
But The Daily Telegraph can disclose that a national review of the system has been ordered following the death of a man turned away by a pilot scheme.
Researchers leading the investigation have said the evidence to back the initiatives – due to be introduced in every part of the country – is “weak”, and it is “unclear” whether the models being brought in are safe.
David Birtwistle, 44, a father-of-one, died from a pulmonary embolism after being turned away by a pilot scheme in Bristol just six days after its launch. Instead of being seen by A&E doctors, he was seen by the GP service – which failed to order basic tests that could have saved his life. A coroner has now written to health officials, calling for a national review of “serious incidents” and “near misses” as a matter of urgency.
Mr Birtwistle went to Bristol Royal Infirmary’s A&E suffering from breathlessness last November. He was discharged, only to return by ambulance six days later when symptoms worsened. He was then diverted to a new “streaming” system designed to relieve pressure on A&E and staff failed to carry out basic tests such as blood pressure.
The scheme, run by Brisdoc Healthcare Services, was halted immediately. The coroner’s report on Mr Birtwistle, issued to NHS England to prevent fatal errors nationwide, urges officials to check the safety of other schemes and set minimum safety standards. It warns all initiatives should include taking a “basic set of physiological measurements” to detect immediate threats.
NHS England has now commissioned a £1 million review into the schemes – although it will not report until next summer, at least six months after every scheme gets under way.
The research proposals, by Cardiff University, state: “The emergency care system is in crisis and evidence is needed urgently to understand how to manage workload and demand to safely achieve the highest standards of clinical and operational care, and whether the recommended addition of colocated GPS adds value.”
It adds that the evidence behind the benefits of GPS working in emergency departments “is weak” and it is “unclear” what impact different models may have on service quality and safety.
The research will compare three models – having GPS working in A&E, next door to A&E, or operating a triage and screening scheme – with traditional methods of assessing patients.
The study will examine all patient safety incident reports for the most frequent and harmful incidents related to GPS and A&E clinicians, the proposals state, with further research tracking 12 study sites, to report by next June.
An NHS England spokesman said: “Guidance to hospitals on making sure patients get the level of clinical care they need has been specifically updated in the light of this, so as to make sure that people who need GP care can get it, and people needing specialist assessment can quickly do so.”