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


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 !!

Posted date

28 August, 2012

Posted time

5:28 pm


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