Journal of accident & emergency medicine最新文献

Background: Patients over the age of 75 years comprise an increasing proportion of accident and emergency (A&E) department attendances. Within this group there is a high incidence of comorbidity, which mandates effective discharge coordination from the A&E department.

Objectives: The aims of this study were to assess the needs of these patients the day after discharge, target patients for appropriate interventions and identify critical incidents.

Setting: The study was undertaken in a district general hospital A&E department that has 62000 new patient attendances per year.

Inclusion criteria: Patients aged 75 years or over who were discharged from the A&E department.

Exclusion criteria: Nursing home patients. Patients without a telephone.

Study design: Pre-discharge information was collected from the medical notes. A community liaison nurse (CLN) then contacted patients by telephone. A semistructured questionnaire was used to assess patients. Patients were risk stratified and appropriate interventions made. Interventions initiated by the CLN were scored from 1 to 6 based on the level of input required.

Results: 551 patients or their carers were contacted by telephone. Existing home support was felt to be insufficient in 44 (8%) cases and in need of immediate intervention in a further 45 (8%) cases. Sixty five (11%) Category 1 patients required no intervention, 223 (42%) Category 2 patients required advice only, 107 (19%) Category 3 patients were referred to their GP, 127 (23%) Category 4 patients required a domicillary visit by a GP or a nurse, 26 (5%) Category 5 patients were at risk requiring urgent home assessment and three Category 6 patients had to re-attend A&E. Advice was given by the CLN on a broad range of issues and a wide range of health care services was accessed. Five hundred and fifty nine referrals were made by the CLN after telephone assessment.

Conclusions: Telephone follow up of patients over 75 attending our A&E department identified a number of areas where care could be improved before and after discharge. This low cost, high quality intervention has the potential for decreasing inappropriate return visits to the department by a vulnerable group of patients as well as improving overall quality of care.

A young person presenting with shortness of breath is common to the accident and emergency department. Usually this hyperventilation is anxiety related or a panic attack, but sometimes it can be caused by a serious underlying condition like pulmonary embolus. Acute shortness of breath in any patient should never be dismissed lightly. It is important to realise that pulmonary embolus can present without chest pain and with shortness of breath as the major symptom. Such patients can be distinguished by close attention to history and examination, risk factors for thromboembolic disease and the use of basic investigations (electrocardiogram, chest radiography and arterial blood gas analysis). A serious cause for shortness of breath must be excluded before labelling it as "hysteria" or "panic".

A retrospective case note review of head injuries in neonates admitted to the Neonatal Surgical Unit in Glasgow between 1990 and 1996 (n=25) was carried out. Most injuries were caused by a fall (68%) and resulted in scalp haematomata and associated skull fractures in the majority of patients. Three neonates were involved in high speed road traffic accidents, and these infants all had intracranial pathology identified by computed tomography. Isolated skull fractures were common and did not appear to be associated with any neurological deficit. Nonaccidental injury was uncommon in this age group. Outcome was excellent in the majority of patients (92%).

Objectives: To examine the profile of regular attenders to an accident and emergency (A&E) department, and to estimate the percentage of the overall departmental workload attributed to this group of patients, together with the resultant cost to the department of these attendances.

Methods: A retrospective study of regular attenders to the A&E department at Hull Royal Infirmary was conducted between 1 January 1998 and 30 June 1998. The information gathered included age, sex, marital status, accommodation, investigations performed, concurrent alcohol use, presenting complaints and disposal.

Results: The A&E department at Hull Royal Infirmary sees approximately 87 000 new patients per year. Forty regular attenders presented 475 times in six months accounting for 1.1% of the departmental workload. The most common presenting complaints were overdose (27.4%), minor injuries (19%), alcohol intoxication (14%) and seizures (10.5%). Eighty per cent of patients were single and 7.5% were of no fixed abode. A total of 191 admissions resulted and the cost to the department for investigations performed was between ł2709.59 and ł3739.85. The cost of inhospital admissions was in excess of ł34000.

Conclusion: Improved management of these patients together with a reduction in their alcohol intake may lead to a significant reduction in both workload for accident departments and hospitals and in the number of regular attenders.