Misleading language over A&E waiting time causes patients unnecessary worry

There is massive pressure on the NHS, exacerbated by the winter flu, particularly obvious for Accident & Emergency departments. It is damaging morale among staff and very misleading for the public, that the BBC and newspapers are reporting that “just 78 per cent of patients across Scotland were seen within the target time of four hours”.

Most are actually “seen” within a few minutes. That fig- ure of 78 per cent in fact refers to the 78 per cent who, within four hours of arrival, have been seen, triaged, examined, investigated (with blood tests, X-rays, CT scans etc), treatments started and then transferred to a ward or discharged home.

What actually happens in large busy A&E department is this: 1) All true emergencies and accidents are seen and treated without any delay. 2) All other people arriving at A&E are seen for triage by a nurse, usually within 10-15 minutes, to decide how ill the person is, and who needs to see them (eg surgeons, physicians, nurses). 3) For patients arriving by ambulance, the ambulance staff remain with the patient until they are seen. 4) Those who need to see a doctor are all seen within 30-40 minutes. 5) The doctor takes a history from the patient and carers, examines, assesses previous drug treatments etc, and as appropriate to each case, sends blood tests, orders X-rays and CT scans etc to make a diagnosis. 6) Blood samples have to be transported, processed in laboratories and reported. 7) X-rays and scans have to be done and then reported by specialist staff. 8) Treatment is started to relieve symptoms and tackle the underlying diagnosis. 9) Arrangements are made for transfer to an appropriate ward, or to return home.

As medicine has become more sophisticated, the extent of investigations has increased and it is extraordinary that so much is done within four hours. It should not be a serious criticism of the NHS if these steps exceed four hours in some cases and an argument could be made to raise that target.

We call on the media not to refer to “patients not being seen for over four hours”. This negative language creates unwarranted anxiety among patients and carers and is hurtful to dedicated hard-working NHS staff.

MIKE LEAN Consultant physician Glasgow Royal Infirmary