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Hard-hitting report calls for overhaul of A&E system

The Royal Victoria hospital's A&E department is at the centre of a major report in emergency care in the north
Seanín Graham

THE first ever probe into the care of the sickest people attending Northern Ireland's A&E departments reveals the biggest cause of injury remains road accidents -with motorcyclists accounting for almost a quarter of crashes.

It also points to the rise in the number of people, especially the elderly, suffering serious injuries as a result of falls from a height.

Authors highlight the 40 per cent transfer of A&E patients to the Royal Victoria hospital in Belfast - where the main specialties such as neurosurgery, burns and critical care is based - and the "burden" this places on the Royal's ICU.

The idea for the audit began five years ago and funding was secured in 2013. The research investigated the care and 'journey' of a total of 84 patients between April and July 2014. Funding was cut last year as they could not replace a post.

The study estimates that 254 patients each year in north suffering "major trauma."

The Belfast and Northern health trusts saw the majority of cases (44 per cent) over the four-month period with Belfast more than a quarter of patients.The average age of patient was 46 and the oldest was 86.

Some of the findings include:

:: DEATH RATES: Twenty-one deaths in the study of 84 cases equating to 25 per cent death rates. Eleven patients died in A&E, five of whom had severe heart attacks. Four patients died within 24 hours of admission and two more within 72 hours.

Among the fatalities, two-thirds had a very severe head injury. There were 41 serious injuries due to traffic accidents - of which 12 were motorcyclists. In pensioners, falls from a height were the main cause of injury.

:: WAITING TIMES: Average time spent by trauma patients in A&E was 240 minutes. The longest waiting time was 17 hours

COMPLIANCE WITH AUDIT STANDARDS

- Concern over poor compliance with emergency stomach surgery or abdominal scan within one hour of attendance (33 per cent compliance against 95 per cent target)

- A third of patients were not seen and managed by Emergency Department consultant within hour of arrival (95 per cent target)

- Less than half of patients (46 per cent) with severe head injuries were transferred to a unit with 24 access to ICU

- CT head x-rays were not performed within the hour in 40 per cent of cases (target is 95 per cent)

TRANSFER OF PATIENTS

Rate of transfer from other hospitals to regional specialities at Royal – neurosurgery, orthopaedics and critical care - is "high". Authors warn of "the burden" this place on the regional Intensive Care Unit.

Of note is the 342 critical care bed days accounted for by just 73 patients.

The report, which is government-funded and published through the north's health watchdog, the Regulation and Quality Improvement Authority (RQIA) makes seven key recommendations.

This includes –

- A&Es in the north should immediately submit information on patients to England’s main 'trauma' system known as TARN (Trauma Audit Research Network)

- Information collected on seriously ill patients should be used to set up a trauma network

- Lengthy waiting times for sickest trauma patients in A&E must be urgently tackled

- Big increase in major injuries in motorcycle crashes and falls among pensioners should be probed by public health authorities

- High level of transfers to Royal A&E from other emergency departments should be examined

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