> I am not so sure I feel comfortable with time lines for
> emergencies.  Where
> is this derived from?  6 hours ?  Why not 7, 5, what about 5 hours 59
> minutes, after all trains arrive and depart on the minute.  On whose
> decision is the 6 hours acceptable ?  The triage nurse ? The
> patient ?. Are
> these dfinitions exclusive or inclusive ?

6 hours taken to develop a definition. Happy for anyone else to argue the
case for 7 hours 23 minutes and 14 seconds. Kind of like 'What is the
definition of 'acute'?' You have to make an arbitrary time scale. Equally,
what is 'significant deterioration'?
But overall, my own thinking is that the definition of emergency has to
include something about time and adverse consequences of inaction.

>
> SHould we not have a more philosophical approach to what an
> emergency is,
> soemthing to do with ability or perception of ability to cope
> with a problem
> maybe ?   Who should define what an emergency is?  The doctor? The
patient?

I put forward my idea of the definition of an emergency (well, really of a
medical emergency). Equally, I could give a definition of a myocardial
infarction, but that wouldn't mean that every doctor, triage nurse or
patient would always be right when they thought someone was having one. So
in answer to your question, my original post was based on me defining what
an emergency is (as should be every post in reply to the question in the
subject line). Working within that definition (or other definition to be
agreed), the person on the spot can make a decision (yes/ no/ maybe) on
whether a condition is an emergency or not (prospectively or
retrospectively). And might be wrong.

> Do we suggest  that we would not see or turn away anyone
> who we think is
> not likely to have a worse outcome if there is more than a
> delay of 6 hours.

We might, we might not. As I said, much of our workload is not emergency
work (and much of our skill retention derives from non emergency work).
What you're putting forwards here is the question as to the role of the
Emergency Department. I hope we're all agreed that our core role includes
care of emergencies. I think we all accept that each department has
different roles, including different levels of care of non- emergencies.
However, if a patient has a condition that does not require treatment as an
emergency, it does seem reasonable for them to be cared for by the best able
person at a time that is cost effective and convenient. 'Turn away' has a
bit of a negative slant,. 'Direct to an appropriate level of care' may be
better. In which case, that is my own practice: if I see a patient with a
condition that can wait for a GP (usually GP, sometimes other care providers
e.g. elective clinics, GU medicine, pharmacists) appointment and is a
condition that will be as well or better treated by a GP than by me, I refer
the patient to their GP.

The 6 hour bit can seem a bit of a sticking point- no GP appointments within
6 hours. However, cases needing to be seen within 6- 48 hours are urgent
rather than emergency cases (by my definition- if you disagree with the
wording, I'd be happy to accept other words, but would still like to keep a
terminology that allows one to distinguish between these classes). No reason
why EDs can't provide urgent care (no reason why other specialities can't
either), but that doesn't make these cases emergencies.

It seem to me that you are defining an emergency as 'a condition treated in
an emergency department' which is certainly one workable definition. What
I'm trying to do is to develop a tighter definition of 'emergency' to
include a subgroup of the patients we treat, which I think may be a more
useful definition for the speciality (indeed it would be interesting to see
breakdowns of workload into emergency and non emergency workload)

>
> I remember someone saying an emergency was 'where the patient
> or the doctor
> could not cope'

As before, a very inclusive and imprecise definition.

>
> Dont get me woring I dont have teh right answer in my pocket
> I'm sure but I
> just feel uncomfortable being didactic about telling people
> they are not an
> emergency because they dont fit in my definition.

Whose definition does someone have to fit to be defined as an emergency. I
feel entirely comfortable about telling patients their diagnosis and being
as accurate about it as possible- indeed I feel there is a prima facie
ethical duty of veracity to one's patients. I do not intend it in any way to
be derogatory when I say that something is not an emergency any more than I
do with any other diagnosis. Merely accurate.

Matt Dunn
Warwick


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