It is estimated that 1,000 avoidable deaths occur in the NHS in England each month. A recent report published by the Royal College of Emergency Medicine (RCEM) has highlighted that an “exit block” in accident and emergency (A&E) departments is a significant contributing factor to these deaths. The RCEM explains that an exit block occurs when patients cannot be moved from the A&E into a hospital bed. 

The causes of exit block are complex but the problem is exacerbated by delays at the “back door” of hospitals where patients, usually the frail elderly who are medically well but require long-term care, often experience significant delays in being discharged because of problems in securing a care package in the community. 

The knock-on effect of these problems includes an increased length of stay for admitted patients, delays in time-critical interventions such as delayed antibiotic administration which can be life-threatening, more cancellations of operations which waste surgical capacity, and an increased risk of adverse events. 

The RCEM has warned that exit block causes up to 13 deaths a year for each A&E department which sees 50,000 patients. Considering that there were 21.7 million A&E attendances in 2013 to 2014 alone, this problem can result in hundreds of avoidable deaths per year. The report also highlighted the harm and distress caused to staff as a result of decreases in departmental function. 

While not all deaths caused by exit block are necessarily avoidable, the RCEM has stressed that any initiatives to reduce mortality must also address exit block. Unfortunately, as the recent statistics highlight, more A&E departments are failing to see patients within the four hour standard, resulting in over-crowding and over-stretched resources. Consequently, the RCEM warns that the problems with exit block in UK emergency departments are likely to grow substantially. 

Naomi Holland, an associate in the Penningtons Manches clinical negligence team, comments: “Clearly, the findings of this report are very concerning and, although the problems facing A&E departments across the UK are not new, they do need to be addressed in the interest of patient safety. Procedures within A&E departments must be implemented to determine and monitor the causes of the inefficiencies within the system so that the issues can be identified and steps taken to rectify them.”