Objectives The NHS Plan has a target that no patient should spend longer than 4 hours in Accident and Emergency (A&E) by the end of 2004. The aim of this study is to describe the attendance ...characteristics of patients spending less than and more than 4 hours total time in A&E. Methods Data were collected from 10 A&E departments in the West Midlands NHS region for the period 1 April 2001 to 31 March 2002. Patients were split into three groups; those spending less than 4 hours, between 4 and 8 hours and over 8 hours in A&E. The groups were compared in terms of their attendance characteristics, these being demography, temporal patterns, arrival mode and disposal. The data were also entered into a multinomial logistic regression using SPSS. Results Overall, 83.0 per cent (range 76.7–94.0 per cent) of patients spent less than 4 hours in A 3.6 per cent (range 0.3–8.6 per cent) spent longer than 8 hours in A&E. The risk factors for spending over 4 hours in A&E were requiring admission, arriving by ambulance, arriving during the night, increasing age and higher levels of deprivation. Being admitted had the greatest effect on time spent in A&E, with a patient being 2.64 times more likely to spend 4–8 hours and 4.84 times more likely to spend over 8 hours in the department. Conclusion This study points to admission and service provision at night as factors leading to long periods in A&E. However, these results can only act as a guide as the problems are different in different Trusts and each should analyse their problem before taking action.
Tetanus is a potentially fatal disease that occurs after contamination of a wound with Clostridium tetani spores. The introduction of comprehensive infant vaccination programmes in the 1960s ...dramatically reduced the incidence of tetanus in the UK. To achieve comprehensive protection against tetanus, the World Health Organization guidelines recommend the administration of the five-dose childhood immunisation regimen and an additional sixth dose, after approximately 10 years, to ensure long-lasting immunity. To supplement these measures, tetanus prophylaxis with human tetanus immunoglobulin is considered essential for incompletely immunised individuals presenting with dirty wounds. However, identifying those individuals who are not fully immunised has, until recently, been problematical. The use of a new rapid, point-of-care immunoassay to assess tetanus immune status may facilitate the optimal management of patients with wounds.
With ever increasing concern over ambulance handover delays this paper looks at the impact of dedicated A&E nurses for ambulance handovers and the effect it can have on ambulance waiting times. It ...demonstrates that although such roles can bring about reduced waiting times, it also suggests that using this as a sole method to achieve these targets would require unacceptably low staff utilisation.
Introduction: To decrease waiting times within accident and emergency (A&E) departments, various initiatives have been suggested including the use of a separate stream of care for minor injuries ...(“fast track”). This study aimed to assess whether a separate stream of minor injuries care in a UK A&E department decreases the waiting time, without delaying the care of those with more serious injury. Intervention: A doctor saw any ambulant patients with injuries not requiring an examination couch or an urgent intervention. Any patients requiring further treatment were returned to the sub-wait area until a nurse could see them in another cubicle. Method: Data were retrospectively extracted from the routine hospital information systems for all patients attending the A&E department for five weeks before the institution of the separate stream system and for five weeks after. Results: 13 918 new patients were seen during the 10 week study period; 7117 (51.1%) in the first five week period and 6801 (49.9%) in the second five week period when a separate stream was operational. Recorded time to see a doctor ranged from 0–850 minutes. Comparison of the two five week periods demonstrated that the proportion of patients waiting less than 30 and less than 60 minutes both improved (p<0.0001). The relative risk of waiting more than one hour decreased by 32%. The improvements in waiting times were not at the expense of patients with more urgent needs. Conclusions: The introduction of a separate stream for minor injuries can produce an improvement in the number of trauma patients waiting over an hour of about 30%. If this is associated with an increase in consultant presence on the shop floor it may be possible to achieve a 50% improvement. It is recommended that departments use a separate stream for minor injuries to decrease the number of patients enduring long waits in A&E departments.
BACKGROUND: The Manchester triage system (MTS) is now widely used in UK accident and emergency (A&E) departments. No clinical outcome studies have yet been published to validate the system. Safety of ...triage systems is related to the ability to detect the critically ill, which has to be balanced with resource implications of overtriage. OBJECTIVES: To determine whether the MTS can reliably detect those subsequently needing admission to critical care areas. METHODS: Analysis of emergency admissions to critical care areas and comparison with original A&E triage code by a nurse using the MTS at time of presentation. Retrospective coding of all cases according to the MTS by experts and case analysis to determine whether any non-urgent coding was due to the system or to incorrect coding. RESULTS: Sixty one (67%) of the patients admitted to a critical care area were given triage category 1 or 2 (that is, to be seen within 10 minutes of arrival). Eighteen cases given lower priority were due to incorrect coding by the triage nurse. Six cases were correctly coded by the MTS, of which five deteriorated after arrival in the A&E department. Only one case was critically ill on arrival and yet was coded as able to wait for up to one hour. CONCLUSIONS: The MTS is a sensitive tool for detecting those who subsequently need critical care and are ill on arrival in the A&E department. It did fail to detect some whom deteriorated after arrival in A&E. Most errors were due to training problems rather than the system of triage. Analysis of critically ill patients allows easy audit of sensitivity of the MTS but cannot be used to calculate specificity.
Objectives—To determine the reasons for choosing between primary care out of hours centres and accident and emergency (A&E) departments for patients with primary care problems. Methods—Interviews ...using a semi-structured approach of samples of patients attending A&E departments and general practitioner (GP) out of hours centres for primary care problems. Results—102 patient interviews were undertaken. Sixty two per cent of A&E attenders were unemployed compared with 41% of out of hours attenders. White people were more likely to attend A&E departments and Asians the out of hours centre (p<0.01) and unemployed were more likely to attend A&E departments (70% v 30%). Some 46.3% of A&E department attenders had not contacted their GP before attending; 81.3% of first time users of the out of hours centre found out about it on the day of interview. Those attending A&E thought waiting times at the out of hours centre would be 6.3 hours (median) compared with a median perceived time of 2.9 hours by those actually attending the out of hours centre. Actual time was actually much less. Conclusion—Once patients have used the GP out of hours centre they are more likely to use it again. Education should be targeted at young adults, the unemployed and white people. Patients should be encouraged to contact their GP before A&E department attendance for non-life threatening conditions. Waiting time perception may be an important reason for choice of service.
...the use of decision support would also help this process, this may be accessed by telephone (for example, contacting NHS Direct for remote support) or by the use of hand held computers at the ...scene. In some areas, ambulance services are now operating systems whereby they book non-emergency transport by time of arrival at each hospital.
Objective: To determine current consultant practice in larger UK emergency departments in the management of severe ankle sprains. Design: Questionnaire study to all UK emergency departments seeing ...more than 50 000 new patients per year. Results: 70% response rate. Most popular treatment was ice, elevation, Tubigrip, and exercise, each of which was reported as used in most cases by over 70% of respondents. Crutches, early weight bearing, and non-steroidal anti-inflammatory drugs were each reported as used in most cases at over half of responding departments. Physiotherapy was usually only used in selected cases. Rest was usually advised for one to three days (35%). Follow up was only recommended for selected patients. Conclusions: The results of this survey suggest that there is considerable variation in some aspects of the clinical approach (including drug treatment, walking aids, periods of rest) taken to the management of severe ankle sprains in the UK, although in some areas (for example, not routinely immobilising, early weight bearing as pain permits, use of physiotherapy, use of rest, ice, and elevation) there was concordance.
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