> although
> precisely what one
> means by "acceptable mortality level" intrigues me...can
> mortality of a
> discharged A&E patient ever be acceptable?
Yes it is. Ultimately all our patients will die sooner or later. There is
such a thing as a silent MI. Many MIs don't have ECG changes. Should we
admit every asymptomatic patient with a normal ECG? The concept of
'acceptable mortality level' is an excellent one. The point is it should be
open and explicit. A and E decision to admit is a complex test. It has false
positives and false negatives. The decision as to where you take your cut
off to trade one against the other is a trust level clinical governance one
(actually a pretty good use for clinical governance). That's why you need
protocols to discharge patients at a lowish risk of a serious disorder. What
I don't like is staff (often junior, admittedly) in other specialities
complaining about inappropriate admissions from A and E but then not
supporting the A and E junior who sends the patient home.
Matt Dunn
Warwick
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