1. Emergency Medicine – 10 priorities
Dr Cliff Mann FRCP FRCEM
President of the Royal College of Emergency Medicine

4. Maximum to minimum ratio
Reported numbers of A&E staff or facility per 100,000 attendances per annum in 2014
Type of staff or facility
Minimum
Maximum
Average
Maximum to minimum ratio
Consultants
5.5
20.8
10.1
3.8
Junior doctors
2.7
14.8
7.7
Career grade Drs
1.0
24.5
7.0
ENPs
5.0
69.0
13.4
13.8
Total nursing staff
39.0
165.0
94.0
4.2
Resus cubicles
2.0
9.0
4.8
4.5
Patient trolleys
6.0
50.0
29.0
8.3
(from the NHS Benchmarking Network’s data)

5. ED unlike in-hours care provided on an appointment system basis has huge hourly variations in consultation requirements

6. Irrevocable loss of capacity
368 registrars
2000 patients each
patients
12 DGH EDs
Working life of 35 years
25 million patients
There is one EM Consultant for every 11,500 attendances.
Productivity increase of 7%

7. Sustainable Staffing EM doctors EM practitioners
ACCS posts
Increase from 225 to 325
Attrition
From 50% to 25%
DREEM
Over 100 in 2 years
Current fill rate for HST 79%
Physicians Associates
RCP
ANPs
Credentialing using RCEM curriculum from May 2016
Real interest in GPs credentialing in EM

8. Whilst it is essential to manage demand on EDs, this should not detract from building capacity to deal with the demand faced, rather than the demand that is hoped-for.

10. Comparative national public spending:

11. £1.6 billion £8.5 million Budget for 186 A&E departments
Average annual budget per department

16. 

17. 4 hr standard

18. Performance against the 4-hour standard is a useful proxy measure of crowding.
‘Performance against the four-hour standard shows how this standard is actually a quite sophisticated measure of complex interactions within the whole of a local health and care system’

19. The main causes of ED crowding include surges in demand and lack of access to beds in the hospital system due to poor patient flow and high hospital occupancy rates
ED crowding adversely affects every measure of quality and safety for patients & staff.

22. Emergency departments (EDs) should be fully resourced to practice an advanced model of care where the focus is on safe & effective assessment, treatment and onward care.