Gonna go where the bright lights and big city meet…

Since I started this blog a few weeks ago, I’ve tried to write a piece about the so-called “inappropriate attenders” that turn up in A&Es all over Ireland & the UK. If the politicians are to believed, they are ruining everything for everyone.

I think “inappropriate attenders” is another one of those phrases like “admission avoidance” which are weighted with an odd kind of patient-blame. Anyway, I was trying to write something but Dr Malcolm McKenzie (@fourhourtarget) managed to say most of what was on my mind in his recent blog post.

I wanted to add three things:

(1) People should be a little but more relaxed about the patients who come to the ED and turn out to be OK. EDs function as a screening service. We want our EDs to have good sensitivity, truly diagnosing the acutely unwell. In order to do that, some false positives might be admitted, but that’s ok, and some people who aren’t really that sick in the first place will need to be seen and discharged, and that’s ok too.

(2) Instead of a blame-y phrase like “inappropriate attenders” we should create some new ones. One example could be “inappropriate outpatients department” where hospitals could rid themselves of “inappropriate attenders” in ED forever by having fair and timely access to specialist outpatient appointments. ED is happy, GPs are happy and patients are happy. I can dream…

(3) I spent three and a half years in the ED at UCH in London. Within a ten minute walk from its front door you had Warren Street, Goodge St, Tottenham Court Road and Euston Square tube stations along with Euston Station with its tube and mainline services. I made a rough calculation that maybe 350,000+ commuters used these stations in the morning. We were a clearly signposted, 16 storey building and so got a lot of walk-up traffic of the primary care variety. I couldn’t blame a frazzled London commuter for coming into us when the GP offered an appointment the following week in the middle of the work day. For the end-user, it’s a no-brainer.

The emergency department is a desire path. People will go where the door is open and use the service they have access to. We should stop being surprised by this.


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