Problems tend to arise in Accident & Emergency because time is short and decisions need to be made quickly. Problems usually involve fast deteriorating conditions which need to be thoroughly investigated. Doctors work on the basis of differential diagnoses. This means they consider what the symptoms might suggest is the underlying condition which needs treating. They will have a list and will test a patient to systematically remove the most serious from that list.
For example, if a child comes in with a high temperature and a stiff neck and perhaps a rash, then there should be immediate concerns about meningitis as a possible diagnosis. Another example might be a patient who presents with shortness of breath and is suffering from a pulmonary embolism – a blood clot on the lung. This will need urgent blood thinning drugs, but shortness of breath may also be a sign of many other things from obesity to a heart condition.
Often it is not for those first meeting the patient in A&E to diagnose but it is important that the patient is referred to an appropriate specialist who is competent to do so in a timely fashion.
Sometimes an A&E doctor will refer a patient to the EAU or Emergency Assessment Unit for a specialist medical opinion. GPs will often refer patients directly to the EAU also and will write a letter outlining what they believe the problem with the patient may be.
TSP Clinical Negligence solicitor Steve Webb was recently on Dream 100’s Ask the Expert where he discussed some of the problems that can occur in Accident & Emergency Departments when resources are stretched and time is short and the impact that this has on secondary services such as walk-in-centres and minor-injuries-units.
Julian Wilson, who leads the clinical negligence team at TSP, has also written an article (Nov 2014) regarding the problems experienced at Colchester Hospital’s A&E department and indeed, the problems that are happening in Accident and Emergency departments across the country.