A&E medics have warned it will be impossible to maintain social distancing and infection control measures if emergency departments return to pre-covid levels of overcrowding.

‘Crowding – a problem that has persisted for years in NHS Scotland’s emergency departments – and covid-19 are fundamentally incompatible,’ the Royal College of Emergency Medicine Scotland has said.

In March 2020 attendances in emergency departments in NHS Scotland fell to their lowest levels since records began.

It came after one of the busiest winters on record that saw numbers turning up at A&E soar.

Responding to the Scottish Parliament’s Health and Sport Committee consultation on resilience and emergency planning related to covid-19, the RCEM representative says this is a challenge that requires a systemic transformation across health and social care services.

It comes as Health Secretary Jeane Freeman has been under increased pressure over hospital-acquired cases of the virus.

In an exchange with Conservative health spokesperson Miles Briggs in parliament today, Ms Freeman said 125 covid-19 incidents had been reported which were potentially associated with 901 patient cases. Meanwhile 894 staff cases had been reported, including confirmed and suspected covid-19.

The outpouring of support for NHS workers' wellbeing witnessed during the pandemic has left some A&E staff ‘bemused’, according to RCEM.

‘Emergency department staff have for some years now had to endure conditions of overcrowding for their patients ‘which have broken more than a few of them’.

‘The biggest threat to the mental health of emergency department staff is the fear things will go back to the way they were. Emergency Medicine should be the safety net for the patient, not the system,’ the representative body states.

Scotland’s emergency departments have undergone significant changes to separate patients more likely to have covid-19, a reconfiguration the RCEM says must continue.

Adequate ongoing supplies of PPE will be needed, alongside virus testing infrastructure that can deliver results quickly.

The RCEM says ‘there is a moral imperative to ensure hospitals never become crowded again’ so that social distancing can be maintained.

Changes that came about as the pandemic hit eased the two biggest issues that had been making emergency departments ‘unsafe and unsustainable’, the RCEM says – difficulties placing patients in appropriate hospital settings and unnecessary use.

To keep the numbers from reaching pre-covid levels, the RCEM underlines the importance of alternative pathways for lower risk patients, leaving emergency departments clear to handle the seriously ill.

The representative body says A&E departments 'have not been physically designed to promote good infection control', with many lacking in adequate side rooms to be able to protect patients at the highest risk.

‘Some departments may need to continue to adapt within current structures, whilst others will need to be redesigned and rebuilt to keep patients and staff safe.’

 

Sign up to our bulletin sent twice a week so you don’t miss out on the latest health and social care news.