SPECIAL INVESTIGATION: The hospitals leaving patients on trolleys for up to 50 hours



21:45 GMT, 17 September 2012

Being rushed to hospital or taking your loved one to A&E can be a frightening experience. However, experts have recently highlighted a disturbing trend that will only make it worse.

They say hospitals are bursting at the seams, and a combination of poor out-of-hours GP services, budget cuts and a shortage of beds mean many patients are being parked on trolleys in A&E corridors and side rooms like left luggage.

Indeed, Department of Health figures, revealed last month by the Nursing Times, suggest nearly 67,000 patients waited up to 12 hours on a trolley in the first half of this year.

Disturbing: Many patients are being parked on trolleys in A&E corridors and side rooms

Disturbing: Many patients are being parked on trolleys in A&E corridors and side rooms

And this may simply be the tip of the iceberg, as NHS analysts say clever number-crunching by hospitals may be hiding the true extent of the problem.

As this Good Health investigation reveals, more than a quarter of hospitals have reported cases where patients have been left on trolleys for 12 hours or more — up to 50 hours in one case. In most NHS hospital trusts, patients waited less than three hours for a bed on a ward (the average was one hour 36 minutes). However, in six (7 per cent) of hospitals the average wait on a trolley was three hours or more.

Leaving patients on trolleys until a bed on a ward becomes available is known as ‘boarding’. Some argue that it’s an otherwise harmless consequence of an over-stretched health system.

The experts disagree. ‘Being on a trolley for an extended time is not good for your health — it can lead to patients deteriorating and is bad in every sense,’ says Dr Peter Carter, chief executive of the Royal College of Nursing.

‘There is a lack of call buttons and water — and many people are, understandably, too embarrassed to tell a nurse that they need to go to the loo.

‘And though words such as dignity and respect trip off the tongue these days, going to the loo on a bedpan in a corridor is one of the most undignified situations I can imagine.’

But there are more serious implications, too. ‘If these trolleys are in corridors, then it is usually not possible to get all the proper monitoring equipment and oxygen next to the bed.’

Patients have died when left alone on trolleys. An investigation was launched at James Cook University Hospital in Middlesbrough in June after a patient suffered a fatal cardiac arrest after waiting on a trolley in a corridor for more than two hours.

‘Long trolley waits can compromise a patient’s health — especially for the elderly,’ says Dr Taj Hassan, vice-president of the College of Emergency Medicine. It increases the risk of complications such as bed sores and dehydration.

To get a clearer picture of the extent of ‘boarding’, we sent Freedom of Information requests to 173 hospital trusts asking for the average waiting time between being referred from A&E and arriving at a bed on a ward.

Out of place Student doctors look intently at a patient. When a bed is found, it is sometimes on the wrong ward

Out of place Student doctors look intently at a patient. When a bed is found, it is sometimes on the wrong ward

The hospital trusts were also asked
for the longest time a patient waited. The results make for depressing
reading. The table below shows the ten hospital trusts with the longest
patient waits.

Though some may argue that these are isolated cases, Dr Carter warns such long waits are, in fact, becoming increasingly common.

was talking to an A&E nurse who was discussing the standard of care
she witnessed in the Eighties and Nineties,’ he says.

‘She said she used to dread the days when she’d go off duty for two days and then see the same elderly people still waiting on trolleys when she came back. Sadly, this is exactly what is happening right now.

‘Ministers can deny it and dress it up with statistics, but we know that this is a reality. We’re warehousing people on trollies in inappropriate places.’

Hospitals argue boarded patients are not abandoned in corridors, but are placed in ‘clinical decision units’ or ‘transitional assessment units’ where they can undergo further observation or tests.

However, Dr Carter argues that in many cases these are corridors and side rooms — but re-branded.

Some hospitals may even stop recording
a patient’s waiting time when they enter these units because,
technically, they have left A&E and been admitted into the hospital.
‘There are increasingly all kinds of euphemisms for these areas, but
they’re basically not designed to provide the best possible care,’ says
Dr Carter. ‘They’re holding pens.’

when beds are found, they are often in the wrong ward — so a patient
who has a heart complaint may be taken to a surgery ward because that is
the only place where the hospital has a free bed.

NHS staff say they are sometimes given little option but to resort to measures such as boarding.

hospitals have managed to tackle long trolley waits by overhauling
their A&E departments. For example, Luton and Dunstable Hospital NHS
Foundation Trust built a larger emergency department, increased staff
and ensured that a senior doctor sees every patient within an hour of
them arriving, helping to identify who will need admitting.

But our investigation suggests that many hospitals are running at breaking point.

also asked all the trusts about their bed occupancy rates and found
nearly two-thirds of hospitals operated at above what some experts
consider safe capacity.

I had to wait for 17 hours

Too long: Kathy Ollis-Brown had suffered seizure at home followed by two more while she waited for a room

Too long: Kathy Ollis-Brown had suffered seizure at home followed by two more while she waited for a room

Kathy Ollis-Brown felt a sense of relief when she got to A&E after a seizure in March last year. But she was then ‘parked’ on a hospital trolley for 17 hours as over-stretched staff rushed by her.
The mother of two was taken to East Surrey Hospital, near Redhill, after losing consciousness briefly at home.
Once at the hospital, Kathy, 43, was placed on a trolley against a corridor wall and suffered two further seizures.
After three hours, she was wheeled into a small side room. ‘There were about 15 of us in there, like sardines — the room was filled with moans and groans,’ she says.
It wasn’t until her husband Bob spoke to the hospital’s chief executive that Kathy was given a bed — 17 hours after entering the hospital.
Tests revealed the seizures were due to an abnormal heart rhythm. The hospital has since apologised, blaming an exceptionally busy night.

‘High occupancy, more than 85 per cent, has been linked to every measurable bad outcome you can think of: boarding, raised infection rates, accidents and staff taking antidepressants,’ says Dr Rod Jones, a statistical adviser who has published research papers on this topic, and works as an adviser to NHS trusts.

He adds that larger hospitals can go up to 90 per cent occupancy, ‘but infection risk tends to kick in around 85 per cent, irrespective of the size’.

Our results suggest that nearly two-thirds of hospitals operate over 85 per cent capacity, with nearly one in three at more than 90 per cent occupancy. Perhaps not surprisingly, most of the hospitals with the longest patient waits had high occupancy rates. Dr Jones says hospitals are under increasing pressure to boost occupancy, as this reduces their costs.’


How long are patients waiting on trolleys
We sent Freedom of Information requests to all 173 hospital trusts in
the UK with A&E departments. We asked for the longest time a patient
waited – from referral by A&E, to being given a bed on a ward. We
also asked for the average time a patient waited. Around half the trusts
supplied answers to the questions.

Northern Health and Social Care Trust
LONGEST WAIT: 50 hours 33 minutes
AVERAGE WAIT: 4 hours 26 minutes
Hywel Dda Health Board
LONGEST WAIT: 46 hours, 38 minutes
AVERAGE WAIT: 1 hour 55 minutes
Belfast Health and Social Care Trust
LONGEST WAIT: 37 hours, 25 minutes
AVERAGE WAIT: 4 hours , 25 minutes
South Eastern Health Care Trust
LONGEST WAIT: 34 hours, 30 minutes
AVERAGE WAIT: 2 hours, three minutes
King’s College Hospital NHS Trust
LONGEST WAIT: 24 hours, 3 minutes
AVERAGE WAIT: 2 hours, 31 minutes
Oxford University Hospitals NHS Trust
LONGEST WAIT: 21 hours, 24 minutes
AVERAGE WAIT: 44 minutes
Univ. Hospital of North Staffs NHS Trust
LONGEST WAIT: 20 hours
AVERAGE WAIT: 42 minutes
Northampton General Hospital NHS Trust
LONGEST WAIT: 19 hours, 39 minutes
AVERAGE WAIT: 6 hours, 54 minutes
Univ. Hospitals Birmingham NHS Trust
LONGEST WAIT: 19 hours, 12 minutes AVERAGE WAIT: 1 hour, 48 minutes
Pennine Acute Hospitals NHS Trust
LONGEST WAIT: 18 hours, 10minutes
AVERAGE WAIT: 1 hour, 9 minutes

Just over half of trusts provided information — some claimed the cost of the time needed for staff to provide the information would exceed that allowed for a Freedom of Information request (450).

Others said that they did not hold the information. In fact, hospitals are obliged to record how many patients wait between four and 12 hours to be admitted to a ward.

They must also report the number of patients who wait more than 12 hours. Some patients may spend this waiting time on a bed in a side-room; however, the vast majority will be on a trolley.

It should be noted that some hospital trusts will undoubtedly record waiting times differently — and this data is intended as a snapshot of patient experience in emergency wards, and not as a scientific study.

When we approached the trusts mentioned in the table below, King’s College Hospital NHS Foundation Trust and Oxford University Hospitals NHS Trust said they had provided incorrect data in response to our Freedom of Information request.

The other hospital trusts said that patients who experienced these long waits were particularly complex cases, who needed to be stabilised in A&E before being moved to a ward, and that most patients do not experience such long delays.

Commenting on our investigation, a Department of Health spokesperson said: ‘Delays to care are unacceptable — patients must be treated with dignity and respect at every stage of their care.

‘We know that, on average, people in A&E in England wait only 51 minutes for their treatment to start and 95 per cent of patients are in and out of A&E within four hours. We are modernising the NHS, so it can continue to improve care.’

Roswyn Hakesley-Brown, chair of The Patients Association, said: ‘The public will be shocked to hear this practice remains an issue in today’s health service.

‘The Government’s drive to save 20 billion from the NHS budget is adding to pressure on the number of beds available — which are already at full stretch from rising admissions to A&E departments. Health chiefs need to act to end disgracefully long waits on trolleys.’