Intended for healthcare professionals


Providing primary care in the accident and emergency department

BMJ 1998; 316 doi: (Published 07 February 1998) Cite this as: BMJ 1998;316:409

The end of the inappropriate attender

  1. I R S Robertson-Steel, Primary care consultant in accident and emergencya
  1. a New Cross Hospital, Wolverhampton WV10 0QP

    Out of hours calls to general practitioners have doubled in the last three years,1 while emergency admissions to hospitals have increased by 16% from 1988–9 to 1993-4, with some hospitals seeing a doubling since 1993.2 3 Yet accident and emergency departments—a major gateway to the hospital—treat a mixed group of patients, and only a small proportion of the 15 million people who visit Britain's 227 accident and emergency departments each year4 are critically ill or injured. What drives the increasing demands on accident and emergency services and out of hours calls to general practitioners is not yet understood, but attempts are being made to manage the workload in a way more appropriate to the problems it presents.

    Until recently the accident and emergency community blamed many of its problems on “inappropriate attenders.” That attitude is changing, with the recognition that many attenders need primary care. Lack of an agreed British national triage system makes valid comparisons difficult, but the British Association of Accident …

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