(UK) Government targets pressure doctors to admit patients

The Telegraph ^ | 11/19/2009 | Katherine Murphy

[markomalley]

The statistics showing when accident and emergency departments discharge or admit patients should worry everyone. What they clearly illustrate is the extent to which healthcare professional’s clinical decision making is tied into the 4 hour A&E target looming over them. This can lead to the complete and utter distortion of clinical care decisions.

Often, diagnosis and decision making in medicine is a waiting game. You order tests, you record vital signs. For some patients the decision to be kept in or sent home might be the same regardless of when you were seen. But the huge spike in decision making seen in the ten minute window before a patient would breach the target is hard to explain away.

Pressuring doctors into making a decision within a set time limit can result in an unnecessary admittance to hospital (with all the wasted money and disruption to the life of the patient and their friends and family that entails) or more importantly a discharge home when more tests and a bit more time would have revealed that the problem was more serious than doctors originally thought.

Surely when your doctor gets around to seeing you at three hours 50 minutes you want their decision to keep you in or send you home to be based entirely on clinical judgement? With stark statistics like these suggesting this isn’t always happening we can see clearly why targets are not always a good thing. They have their place and can help some patients and improve services but they are not the only answer.

[markomalley]

That is one other thing that hasn't been addressed so much. Cooking the books and making decisions for the purpose of keeping the metrics looking good.

[jimt]

Government employees cooking the books and making decisions for the purpose of keeping the metrics looking good ?

I'm shocked, SHOCKED I tell you !