Emergency care networks

Hospital based emergency care has been an integral part of the NHS since 1948. First medical and surgical emergencies were referred directly to the acute care firms and were seen initially by house officers. Patients with trauma, both minor and major, were seen by casualty officers in the casualty department. Over the next 25 years, “casualty” gradually evolved into accident and emergency medicine, which became an independent specialty in the 1970s. Since then the number of people attending emergency departments has inexorably risen, with a similar increase in the number of people “waiting for attention.” The philosophy was “first come, first served,” but with the most seriously ill patients taking precedence.

The situation changed dramatically in 2000 with the publication of the NHS Plan.1 This contained two targets for emergency departments—that by 31 March 2003, 90% of attendees in emergency departments should be seen and discharged or admitted within four hours, and that this figure should rise to 100% (now amended to 98%) by the end of 2004. These targets were supported by a key document, Reforming Emergency Care, in …