I'm a doctor who has worked extensively in A&E. 4 hour waiting targets seem like a great idea, the public feel they will be seen and treated quicker. I have seen, unfortunately, many episodes of patient care being compromised by the 4 hour waiting target. Patients will simply be moved out of the department after 4 hours if they require an admission regardless of whether essential treatment has been completed or not. I've seen patient's not get essential blood tests/ECGs/x-rays as the Nursing staff have been too panicked by the wrath they will incur from management if the patients "breech". I have seen a patient die as they were transferred to an inappropriate ward to make sure they did not breech when they were very unwell and did not get highlighted to the doctors on call. The four hour waiting target compromises patient care and makes A&E even more stressful and challenging when Doctors and Nurses should be concentrating on making correct decisions in patient care and management. I think patient flow through A&E needs to be focused on but an arbitary, inflexible target of 4 hours is dangerous. I personally have been forced into making a rushed decision on the care of a 1 year old child as they were about to breech the 4 hour target. What if this was your child?

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