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EDITOR’S COMMENT

'Nurses are concerned that the public misunderstand A&E'

  • 36 Comments

This week’s #NTTwitchat revealed concerns from a number of nurses about the public not really knowing what an A&E department is for.

We’d started our regular weekly chat on Twitter to talk about whether the lengthening waiting times in emergency departments were the result of staff shortages. But although resources were mentioned as a factor in the hold-ups and overcrowding, many nurses cited rising numbers of admissions as the biggest cause for concern.

And that rising number of people is down to their failure to appreciate when a trip to A&E is necessary, and where a visit to the local GP surgery or a call to NHS Direct will suffice.

Many nurse tweeters from around the country spoke about awareness campaigns on the back of buses in their local towns and cities and national advertising to increase the public’s understanding of where they can go to get help. But it does not seem to work. If you’ve ever spoken to an A&E nurse, you’ll know that in many of their shifts they see “frequent flyers” along with a range of first-timers who come with complaints that could easily be fixed elsewhere.

NHS Direct does encourage people to administer their own self-care and cut A&E admissions, but some nurses were saying that patients grew frustrated by their belief that there would be long wait times for callbacks from nurses. Having used the service, I don’t think I’ve ever waited as long as the average A&E stay, and certainly it’s much easier to wait in the comfort of your own home than it is in a jam-packed A&E department. Nurses joining us on Twitter were perplexed as to what more could be done to get that message out there and encourage more appropriate access of healthcare services.

The public health campaigns about smoking cessation, fitness and lung and bowel cancer are effective and persuasive, and that same focus on accessing services could prove just as effective at reducing demand on A&E services and saving money.

And there are other ways to tackle A&E overcrowding. This week, Cardiff and Vale University Health Board unveiled a new scheme to film drunken party-goers who were admitted to a triage clinic, and then give them the option of viewing the footage once they had sobered up to deter them from overindulging again. The pilot is easing the burden from A&E, and could be rolled out nationally if academics analysing it deem it an effective way to reduce admissions and a helpful part of the substance misuse strategy.

This innovative way of reducing the pressure at source is one example of re-education of the public about the impact of their behaviour, but others like it would surely benefit the health service. 

If you want to take part in our popular chat with nurses #NTTwitchat, join @NursingTimes on Twitter at 1pm every Wednesday, and search for the conversation using the hashtag.

See you on Wednesday. Until then, have a good week.

  • 36 Comments

Readers' comments (36)

  • the public are blamed for overcrowding A&E in the UK but there are at least two problems here.

    1. there are no suitable alternatives such as 24 hour walk inc cinics as elsewhere and lack of immediate appointments 24/24 with GPs

    2. the sick are not there for the convenience of the health services. it is actually the other way round and people can't always hang around in their own homes waiting for call backs if the only means of getting to the hospital is dependent upoin the timetables of often very poor publiic transport services and may also be the last thing people want if they are sick or injured, but not sufficiently so to call an ambulance, and taxis except in a real emergency can be a very costly alternative. Just waiting for a bus in the freezing damp for an hour to get to a supermarket when the serivice is advertised for every 20 miinutes will tell you this!

    It is not alway possible to rely on neighbours and many, especially the elderly living on their own, who have relatives, they may not live nearby.

    I wonder if staff just realise how it can feel for patients who are ill, had an accident or are worried and if they cannot get adequate, timely and caring attention this just exerbates their condiiton.

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  • The problem of unsuitable patient visits to A&E is the rolling programme of closures of nurse led NHS Walk-In Centres. One recent example in East London saw a WIC closure with a fractional transfer of staff to a local A&E. The local A&E was happy to absorb the funding, but not so keen on the 70+ per day walk-in patients seeking primary care. The alternative WIC sites were some distance away and working GP surgery hours.

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  • "...not so keen on the 70+ per day walk-in patients seeking primary care."

    why age discrimination? surely every patient has the same entitlements to care when they need it although people in some age categories such as babies, children and the elderly need staff with specialist knowledge and training.

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  • @Anonymous | 28-Aug-2012 11:45 am, I'm quite sure the previous poster wasn't referring to the age of the patients, but to the 70 extra people per day finding their way into the A&E department that would previously been seen at the WIC.

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  • kirsty ivison | 28-Aug-2012 1:16 pm

    thanks for pointing it out and apologies to Chris Stevens | 28-Aug-2012 10:31 am for misreading the comment.

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  • Get G.P.s to do some/any work - often they can't even be arsed to refer properly. That would cut down our patient workload by 30% at a stroke.

    The U.K. model of emergency care with the expertise all at the top of the (often work shy, got empires to build)pyramid and trainee docs (90% of them not wanting to work in the pariah speciality) doesn't work well for the public and probably never has.

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  • This is NOT a new debate. The question about "inappropriate attenders" is one that I can recall being rehersed many times over many years ! Public education plays a part but patients who are ill or in pain need and are entitled to professional care.

    The perception of what is "appropriate" will vary between the patient and A& staff and I would argue that it is not the A&E staffs prerogative to make value judgements about "appropriateness" of an individuals decision to seek care..

    "Appropriate" is NOT related to diagnostic category, symptoms or time interval.

    One anecdote to give you some thought !

    An middle aged man presented to an A&E complaining of a sudden loss of vision in one eye. The triage nurses first written comment related to the man "smelling " of alcohol ! The man's B/P and pulse were recorded as being within normal limits and his pain score was said to be zero. No formal test of visual acuity was undertaken and he was placed in the waiting room and labelled a triage category 5.

    When eventually examined (some hours later) the gentleman was found to have a central retinal arterial occlusion. ( AN OPHTHALMIC EMERGENCY!) The gentleman freely offered as part of his history the fact that he had consumed a "stiff whisky" after he suffered a loss of vision and whist awaiting his son to transport him to hospital.

    The nurse who triaged this man made a serious error and allowed the "smell of alcohol" to cloud professional judgement. This was compounded by failing to objectively test the patients visual acuity! (negligence?? )

    Before labelling a patient as being an inappropriate attender LISTEN to what the patient says, assess s/he holistically and triage appropriately and on clinical grounds only!

    Every A&E department will have a percentage of patients who's needs may have been (better?) met in a different care environment. If one accepts that premise then the whole question of Out of Hours GP provision, the availability of urgent GP appointments etc. arises. These issues are NOT new !!






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  • I don't believe there is such a thing as an 'unsuitable patient' in any service. the fact they present to medical services indicates that they have a need, what ever this may be, for professional attention.

    such needs should be identified and the patient directed to where they will obtain the most appropriate assistance whether it be physical, mental or other. It there problems are not considered clinical but rather social A&E and other services should have adequate information on all of the relevant services and be able to put them in touch with these according to the level of urgency.

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  • Its in the title accident or emergency. People see many minor things as an emergency which can wait. Dental problems which have gone on for weeks but have not seeked dental advice. Patients that don't want to go to there GP or can't get an appointment. Minor injuries that don't have a dr or X-ray after a certain time. GP's that don't go out to see a patient so call an ambulance instead

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  • Anonymous | 28-Aug-2012 10:40 pm

    that is why separate services are needed. one for major emergencies and 24/24h walk in services where patients can be rapidly referred on if their needs are urgent. setting and up and managing adequate medical services is not that complex.

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