In message <[log in to unmask]>,
[log in to unmask] writes
>The effect of
(charging attenders)
>was only temporary and inappropriate attendances once
>again rose to the normal levels.
>
>Moreover we are also
>seeing an increased number of patients who present to us late thus with
>increased morbidity and complications with resultant longer hospital stays.
>
>Continued public education is definitely the key.

Interesting to hear the international perspective on an old problem. The
decision whether to charge an "appropriate attenders" fee versus
"inappropriate" would not I suspect be a burden welcomed by most A&E
docs.

It may sound perverse, but I think keeping reasonably long waits, allied
with good triage by experienced staff to make sure the genuinely needy
are attended to expediently, has some place in disuading the "wasters"
from staying. I'm sure we have all heard the phrase "What do you mean
the wait's 90 minutes, I can't wait that long, the Kebab shop shuts in
20 minutes."

Question: How much of the exponential rise in GP attendences might be
attributable to replacement of "turn up and wait" with an appointments
system for nearly all consultations (including "urgent")? Note that
attenders to GPs have risen faster than to A&E (with in-built long
waits).

This is something that concerns me about Nurse Practitioners working in
A&E, and to some extent in GP land. It will be interesting to see
whether ENPs, by making it even easier for the patients with minor or
non-existent pathology to be seen quickly, actually attract more of
exactly that group of patients.

The problem is compounded by encouraging people's maladaptive illness
behaviour by allowing Junior docs to over-investigate and over-treat
them, merely re-inforcing their misplaced belief that they are actually
in need of urgent medical attention. Along with educating the public,
perhaps we need to look at the impact of our own management on
inappropriate attendences.

Kent police have today announced that frequent (3 occasions) misusers of
the 999 call to Police will be disconnected by BT (with appropriate
written and personal warnings, and presumably attempted re-education).
Having heard from a Paramedic colleague recently about a 2O year old
bloke who dialled 999 for an Ambulance more than 24-hours after
sustaining a sprained wrist, I wonder how long before the Ambulance
service has to look at this. Only last week, one ambulance service (was
it Essex?) announced that it was looking at not attending all calls for
help with a fully crewed ambulance. Instead, a 'phone triage officer
will despatch a paramedic practitioner or GP (don't flame me, its not my
idea) to deal with those that clearly didn't need A&E attention.

===========================================================================
Dr. Gautam Ray (e-mail: [log in to unmask])
Sussex, U.K.
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To err is human, to forgive is not management policy
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