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'For many A&E is just the easy option'

Ben Mullin

The most demanding part of the year is approaching – we can already feel the beginnings of winter pressures.

The volume of patients coming through the front door reaches new levels each year. Do they all need to be in accident and emergency (A&E)? No, but we’ll get onto that.

Overcrowding in A&E is a national crisis; it impedes the department’s functionality and safety. There is extensive evidence that when departments are at high capacity – 90% and above – adverse patient outcomes increase significantly, including mortality.

With high attendance levels compromising safety, patient flow becomes the rescuing factor.

“The back door of the hospital can be just as promblematic as the front”

Getting patients out of the department – whether it is through discharges, admitting them to wards, or referrals to walk-in centre or GPs – helps restore the ability to offer safe, high-quality care.

Much of the congestion derives from the department filling up with patients who need to be admitted – but having no base ward to go to. The back door of the hospital can be just as problematic as the front in this situation.

Hospital wards fill up with medically fit patients awaiting spaces in nursing homes or care packages to commence in the community. With a growing, ageing population and tighter financial constraints on local authorities – the ‘bed blocking’ is only going to worsen.

Another issue is the misuse of A&E departments – patients presenting with problems that can be solved elsewhere. By coming into the department with minor ailments you escalate the waiting time, delaying legitimately unwell attenders.

The NHS estimates between two and three million people who come to A&E each year could have their needs addressed in other parts of the urgent care system. Some examples of inappropriate reasons for attending A&E include: dandruff, needing emergency contraception, being unable to sleep, months history of back pain and the common cold.

“There still seems to be an ongoing widespread lack of awareness of other options”

Pharmacies, GPs, walk-in centres and self-treatments from supermarkets can solve all of these issues. A&E departments do not need the extra strain.

Despite numerous public campaigns, there still seems to be an ongoing widespread lack of awareness of other options, A&E is just the easy option. Blaming patients for going to the ‘wrong place’ when they need care and support is the wrong way of looking at the problem.

Not only do the general public need a further education on which services are available but there need to be more options available out of hours. In essence, the whole health and social care services need financial investment – despite this certainty everyone is more cash-strapped than ever.

Ben Mullin is charge nurse, Royal Liverpool A&E


Readers' comments (2)

  • Presenting at A/E with minor ailments has, unfortunately become the norm. There needs to be a robust system in place to turn these people away or direct them to the appropriate service, which is not always the GP. Far too often I hear patients say ‘should I go to A/E?’ My answer is usually, ‘it’s not an accident or an emergency, so no, absolutely not.’ The problem is the expectations of the public are far too high. They expect a fast service, as if in a fast food outlet. Waiting for a non-urgent appointment in Primary Care can be just too long for some, so A/E is an easy option.

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  • Many GP surgeries have become super surgeries with no hope at all at meeting the demand of routine patients that they are actually paid to care for. Many GP's only work part time but are still allowed to stuff their books full of patients they know they cannot see. Restrict patient numbers on the books according to how many hours a GP is actually available lo to see them. Yes, this will hit GP's in the pocket but where else do you sign a contract to deliver a service that you are not required to deliver ... being a GP seems like money for old rope.

    When a patient visits a hospital, that service should be charged to the GP practice, after all they are the folk paid to provide care fro the patient.

    Folk turning up at A&E ... what happened to triage at the door? Keep A&E units locked and don't allow anyone in until they have been triaged. Anyone with a non urgent issue should be turned away without question. This is not rocket science!

    Weekend drunks should be managed by the police, yet they fill many A&E's wasting valuable time and denying urgent cases from getting the care the need.

    Many of the problems have very simple answers, we just need someone with the balls to enforce the rules.

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