Emergency delays

EDITOR,—Luisa Dillner reports that one of the reasons for delay in admitting patients seen as emergencies in the accident and emergency department is that doctors from the teams on take are in theatre or outpatient clinics.1 This situation could be improved if accident and emergency medical staff rather than ward doctors were responsible for deciding which patients should be admitted. In addition, emergency treatment could then be started by the accident and emergency staff.

The perceived advantages of ward doctors going to the accident and emergency department are that they prevent inappropriate admissions and that diagnostic accuracy is increased. A recent study of 1200 patients in Belfast compared admitting practice in two accident and emergency departments with similar staff, number of patients, and catchment population. In one department patients were seen and admitted by the accident and emergency doctors; in the other the decision to admit was taken by the team on take. There were no significant differences in rate of diagnostic error or inappropriate admissions between the two departments. A survey of 153 consultant led accident and emergency departments throughout the United Kingdom showed that the decision to admit was the responsibility of the accident and emergency doctors in only 6%. Clearly, detaining medical and surgical patients in the accident and emergency department for assessment by the ward doctor has no benefit to either the hospital or the patient, and the accident and emergency doctors should be given admitting rights.