Agree entirely - depsite the fact that ED attendance continues to rise and resources become consequently scarcer expecting Joe Public to make this sort of clinical decision is risky - 2 recent examples spring to mind:
1 - middle aged man books in to ED with 'sore throat' - was about to be re-directed to the WIC 200 metres down the road when he developed stridor and was admitted (subsequently intubated) with epiglottitis
2- young female books into ED with 6 week history of cough and localised reaction to OTC medication - found to have a lymphoma and pleural effusion on CXR
Had they made the 'right' decision I wonder at the consequences - there is a perception amongst ED staff and the public that UCC's/WIC's are not working and instead of throwing more money at them just invest in accommodating them safely rather than expect them to 'symptom sort' before deciding where to attend - as you say in one NHS
Jim
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From: Accident and Emergency Academic List [[log in to unmask]] on behalf of ACAD-AE-MED automatic digest system [[log in to unmask]]
Sent: 24 March 2013 00:00
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Subject: ACAD-AE-MED Digest - 18 Mar 2013 to 23 Mar 2013 (#2013-21)
There is 1 message totaling 139 lines in this issue.
Topics of the day:
1. Policy lurches
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Date: Sat, 23 Mar 2013 07:47:27 -0000
From: Rowley <[log in to unmask]>
Subject: Policy lurches
I have often said that a national health service is the single worst way of
providing health care, and every day brings further evidence of this. A few
years ago, the mantra was 'the same service wherever you accessed the health
care system' - a view that I think most reasonable clinicians agreed with.
Now there appears to have been a complete volte face. Our departments have
been festooned with huge, tasteless and downright wrong plastic posters on
rolls with a set of people who 'shouldn't be in A&E' similar to these:
http://www.door22.co.uk/2011/11/choose-better-campaign-nhs/
The usual error is made of confusing presentations with diagnoses and
expecting the public somehow to know that 'severe earache in a child' or a
'minor sports injury' are indeed trivia and have no significant
consequences. They often don't know and can't tell.
With the privatisation of General Practitioner co-operatives and
introduction of 111 (anecdotally, this led to an overnight 27% increase of
workload for one of the ambulance services) a series of policy decisions,
presumably not made by clinicians, have only served to alienate and confuse
the public further.
With kindest regards,
Rowley.
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End of ACAD-AE-MED Digest - 18 Mar 2013 to 23 Mar 2013 (#2013-21)
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