Danny - we've been doing exactly that for the last 8 - 10 years. It's not
so much a question of refusing access, it's more a question of re-direction
to the appropriate specialist which is normally GP but could be dentist etc.
It's actually doing the patient a favour - who treats their Primary Care
problem best? - Primary Care Specialist or A&E SHO under the supervision of
A&E Consultant who's doing pretty well to keep up with developments in A&E
without being able to tell you what the current primary care thinking on
(for example) treatment of a rash??
It's also good for our proper A&E patients who's waiting times to be seen
are reduced - significantly so.
It's also good for staff morale.
If you were the patient who mistakenly thought that A&E was the correct
place to go would you prefer to be directed to the appropriate specialist or
have an A&E SHO have a crack at your problem purely because they feel
obliged to do so because you turned up? It doesn't look too good when it
all goes wrong and the A&E guys say 'no, I wasn't the appropriate
specialist to treat this, of course it's gone wrong' - if I was the patient
I'd be most miffed at not being directed appropriately!
Anyway where's our pride? We're here to provide specialist A&E work - not a
half baked attempt at work belonging to another speciality and making do any
deficiencies in their system (eg. couldn't get my doctor - I don't want to
start a row with the GPs, I'm standing up for your expertise! - but that's
the sort of excuse given in A&E, whether it's true or not!). Would a
Consultant Cardiologist treat the in-growing toenail who turned up in
his/her clinic? - 'Cheek!' we'd say if we heard that a patient did that -
yet old jack-of-all-trades A&E doctor thinks nothing of it!
I've found it difficult to produce written protocols for my triage nurses -
it's one of those things where common sense is essential. They can however
still be triage categorised even if they're not A&E appropriate eg. Primary
Care appropriate Cat 3(eg. very painful period pains) - can be re-directed
with the advice to be seen today and possibly an appointment made for them
by the Triage Nurse - we're not turning you away - we're doing our very best
to help you (can increase the triage nurse workload); GP-appropriate 5 (eg.
10 year history of knee pain - how many A&E Depts still see those?!) - make
your own appointment sometime. (This means that I believe that there are A&E
appropriate 5s - eg. ankle injury few weeks ago - takes lower priority than
the pile of ankle injuries sustained today - different Depts will have their
own methods of dealing with these).
The only formal complaints I've received have been when a patient so
re-directed has been referred back to hospital for admission (eg. if the
painful period above needed hospitalisation for whatever reason) - so common
sense must be used and, as I've said above, difficult to formalise in
writing.
It will only work if the nurses have loads of support from the A&E
Consultant.
It's useful to get the GPs on board but you certainly don't need their
permission to not treat problems you're not trained to deal with.
Anyway, that's far more than I normally write (or say). Just my opinion and
that's the way I run my place - I think it makes for better quality A&E
care.
Nick Jenkins
A&E Consultant
Abergavenny
http://www.ae-nevillhall.org.uk
-----Original Message-----
From: Danny McGeehan [mailto:[log in to unmask]]
Sent: 10 August 2003 19:30
To: [log in to unmask]
Subject: Turn them around
Colleagues
Do any departments have any robust triage or other protocols than I can look
at regarding Primary Care attedances to A&E. Our numbers are going up at a
rate of 10% and we are seeing more primary care patients attending for one
reason or another.
Our orthopods are stating that they will no longer see what they deem to be
inapropiate A&E referrals.
With Trick and Treat it is obviously becoming easier for the patients to
access A&E. Basically I want to know if we can turn them around and
dispatch them back to their GP's and hence would value any comments from the
list.
Kind regards
Danny McGeehan
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