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ACAD-AE-MED  February 2005

ACAD-AE-MED February 2005

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Subject:

Re: Where are they going to go?

From:

"Dunn Matthew Dr. (RJC) A & E - SwarkHosp-TR" <[log in to unmask]>

Reply-To:

Accident and Emergency Academic List <[log in to unmask]>

Date:

Fri, 18 Feb 2005 15:35:16 -0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (50 lines)

> Here's a challenge:
> Define "primary care attender". I think the question has been asked
> before.
> ...preferably in a way that allows me to plug the criteria into the
> database and ask it for some evidence, not just anecdote.

Primary care is the first attendance for a condition. Hence the "Primary".
There are, however, two main exceptions: GU medicine and Accident and
Emergency. So unless the patient has been referred, anything other than a
STD, an Accident or an Emergency is "Primary Care". Leaving aside the STDs,
an "Accident" is an acute injury within the previous 48 hours (which is
specifically not covered by the GP contract); an "Emergency" is a condition
where delay in treatment for more than a few hours is likely to cause
significant risk or detriment to the patient.
So sift out patients referred to you; patients with injuries under 48 hours
old; patients with new onset moderate or severe pain, acute physiological
disturbance (could debate the parameters) including dyspnoea and
neurological signs or symptoms and the rest is primary care.
I suppose you could also use this as a triage tool between out of hours
primary care and A and E.
If you wanted to look at it prospectively, you could have a list like that
and ask your triage nurse to tick a box or fill in an "other" free text as
to why this patient was an Accident or Emergency.

If you want to separate urgent primary care from A and E (and there are a
number of reasons why you shouldn't, but different things work in different
departments) and things broke down in your discussions with the GPs, then
you could look at using this for triage- anything not an A or and E asked to
see their GP that day (and like other specialities, won't be seen by you
unless referred by the GP).

Of course, an alternative definition of an emergency is "Anything the
patient thinks is an emergency" is which case you could define it either by
asking the patients or by assuming that they've read and understood the red
sign above the door and that there's no such thing as a primary care
attendance.

Matt Dunn
Warwick


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