Intended for healthcare professionals

Education And Debate

Improving care in accident and emergency departments

BMJ 2001; 323 doi: (Published 07 July 2001) Cite this as: BMJ 2001;323:39
  1. Lee A Wallis, specialist registrar,
  2. Henry R Guly, consultant
  1. Accident and Emergency Department, Derriford Hospital, Plymouth PL6 8DH
  1. Correspondence to: L A Wallis
  • Accepted 23 April 2001

Many articles have highlighted deficiencies in the care delivered by accident and emergency departments in the United Kingdom. We examined the provision of services in these UK departments, on the basis of a systematic review of the literature and an analysis of papers critical of the services.

Summary points

Many articles have criticised the standard of care delivered by accident and emergency departments

Most care in accident and emergency departments is delivered by senior house officers

To improve the standard of care, more middle and senior grade doctors are needed

Senior house officers should be allowed to spend an introductory period shadowing more experienced doctors


We hand searched the Journal of Accident and Emergency Medicine (now the Emergency Medicine Journal) for research or audit articles critical of accident and emergency care published from January 1996 to December 2000. For the same period we also conducted a literature search using Medline and Embase (with the WebSpirs interface) and the Cochrane Controlled Trials Register (under the search term “accident and emergency”). Articles were included if they primarily criticised management of accident and emergency departments or if they highlighted some deficiency in care or suggested that a specific area might be improved on.

Emergency medicine in other countries is organised differently from that in the United Kingdom, so we excluded papers describing emergency care outside the United Kingdom. We also excluded case reports and nursing journals (as we tried to focus on problems with medical care). From here on, we use the term “emergency” to denote “accident and emergency.”


We found 56 relevant articles (see references w1-w56 on the BMJ's website). Some problems were identified by more than one paper; problems were found in 35 different areas (table). Some of the identified problems were specific (for example, giving advice to women on oral contraception …

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