Resuscitation of accident victims can take some time

Martin Shalley, A&E consultant at Birmingham's Heartlands Hospital, says staff face daily battle to meet the target for patients to be seen, treated and discharged within the four hour limit.

He said staff worked extremely hard to ensure patients were dealt with quickly.

"We have nurse practitioners to help to see the walk-in patients. Nurses also see some patients with minor illness.

"We also have an assessment unit we can transfer patients to who need to see a physician or a surgeon. When patients move there from A&E, the clock has stopped ticking.

If a patient does need to stay in A&E for longer than four hours, they do Martin Shalley

"But without those things, and the resources to do that, we wouldn't be able to meet the targets at all."

However, Mr Shalley said that there were some occasions where patients needed to stay in A&E for longer, and there was just no way the four hour target could be met in those cases.

"Sometimes you just have to bite the bullet. If a patient does need to stay in A&E for longer than four hours, they do. It's fine.

"It may be that there are no beds in the intensive care unit. Or they need a lot tests, or a patient may need to be resuscitated. It can all take time."

He said having just a few patients in a day who needed to stay for longer meant it was extremely difficult to meet the four-hour target.

"In a department such as ours, if you get five or six patients who breach the target in a day, it is very difficult for us to meet our target of dealing with 98% of patients within the four hours.

"That does put pressure on your working practices, especially when the clock ticking down."

"But we just say, if the care they need has to be in A&E, we accept that it's going to be a breach."

He added: "It's not been my experience that patients have been moved inappropriately."

'Every attempt'

Mr Shalley added: "It's not just us who feel that pressure. It has an impact right across the hospital because of the need to have somewhere to move the patients to - managers are under pressure, as are physicians and surgeons. A&E is just where the focus is."

Heartlands met the December 2004 target of having 97% of patients treated or discharged within four hours, and has already met the March 2005 target of ensuring 98% of all A&E patients are dealt with within that time.

The casualty department there sees between 250 and 300 patients a day.

Mr Shalley said: "We do all believe in targets. They have improved emergency care.