Letters

When is an emergency department not an emergency department?

EDITORRecently, a young couple, equipped with backpacks and bedrolls, walked into our local accident and emergency department at about 11 pm, climbed into sleeping bags, and set their alarm clock. Early next morning, roused by their alarm, the couple rolled up their bags and left.

What was the explanation for this behaviour?

It was not careful preparation for attending a department in which the waiting time can often be eight hours or more. The young couple, who lived in Surrey, had booked a holiday that started with a morning flight from Stansted Airport. Rather than get up at 4 am to get from Surrey to Stansted, they had worked out that it would be easier to spend the night nearer to the airport, and that our emergency department would be the safest (and cheapest) place in which to do this.

This curious but true story may raise a laugh, but it also raises a far more serious problem: that of the current abuse and misuse of emergency services. Initiatives involving patient education or NHS Direct are having minimal impact in stopping the public using emergency departments inappropriately.¹ Departments are still overrun by patients with conditions that can be treated in primary care, with the result that waiting times remain lengthy and staff are subject to abuse by tired and tetchy people.

Is it time to invert the knowledge pyramid and put experienced doctors back into primary decision making roles? An emergency consultant, in partnership with an experienced nurse, could effectively triage (and weed out) patients at the first point of contact. Only patients with a genuine emergency would gain access.

Finally, in this era of rebranding, where accountants become days of the week, steel firms morph into male voice choirs, and the president of Turkmenistan renames the months of the year after himself and his mother, we should perhaps follow the American example and rename emergency departments emergency rooms. Then put a large legend on the door defining emergency for each patient about to pass through it: "An unforeseen occurrence or combination of circumstances that is potentially dangerous and calls for immediate action."²

Sue Collinson, project officer. 
WHO Collaborating Centre for Research and Training for Mental Health, Institute of Psychiatry, London SE5 8AF

Trevor Turner, consultant psychiatrist. 
East London and the City Mental Health NHS Trust, Homerton Hospital, London E9 6SR