Emergency Medicine in the UK - Emergency Medicine: A guide for patients

Emergency Medicine is a “specialty”. That means that the senior doctors (consultants) who work in the emergency departments (EDs or A&Es) have undertaken specific training to learn how to look after emergencies.  The specialty of Emergency Medicine has been developing rapidly in the UK for a number of years. It started off being practised in “Casualty” departments by doctors from a number of different medical backgrounds, but now has its own training programme, examinations, and professional college to ensure that  standards are high.

Because the way that healthcare is provided for patients in the UK   has been changing there are still a number of different terms used by different people. Casualty departments are now known as “Accident and Emergency” Departments, or as “Emergency Departments.” Specialists in Emergency Medicine may be known as “Consultants in Accident and Emergency Medicine,” or as “Emergency Physicians.”  It doesn’t matter so much what they are called, they all do the same thing. Doctors, nurses and other professionals working in Emergency Departments are dedicated to the care of acutely ill and injured patients of all ages, and with all the different problems that can present as emergencies.

Not all acute problems need to be dealt with in emergency departments, and there are now a number of different ways in which patients can access help. If you want to know where your nearest service is there is website which should be able to help at:

http://www.nhs.uk/servicedirectories/Pages/ServiceSearch.aspx

NHS services providing out of hours and urgent care

NHS Direct is a 24-hour telephone advice service which can give advice about health problems, and how to access NHS services. NHS Direct also has a website: http://www.nhsdirect.nhs.uk/

It is possible to access GP services out of hours. If you don’t know what arrangements are in place for your area, NHS Direct should be able to help, or GPs should leave details on their answer phone services / practice information.

NHS Walk-In Centres and Minor Injuries Units are designed to deal with minor illnesses and injuries. They are usually staffed by nurse practitioners (specially trained nurses), and sometimes by other practitioners, with a lot of experience and expertise in treating minor illness and injuries. Some of these units have doctors working alongside the nurses or nearby, and some units have X-ray facilities. Many have links with local Emergency Departments. If you have one of the following conditions or illnesses, you are probably best going to the nearest NHS Walk-In Centre or Minor Injuries Unit:

Minor injuries units may not be equipped to deal with very young children, or with more serious conditions such as:

These are the sort of conditions that may be best treated in the Emergency Department or by your own GP.

Emergency Departments

Emergency Departments are departments based at the “front door” of a hospital that specialise in the care of acutely ill and injured patients. Most departments deal with patients of all ages and with all conditions, although there are some departments that see only children, or only adults, or only patients with eye problems.

Various healthcare practitioners may work in Emergency Departments, including nurses, physiotherapists, psychiatric nurses, and doctors. The care in Emergency Departments is supervised by specialists in Emergency Medicine (Emergency Physicians), whose job is to ensure that the patients passing through these departments receive care of the highest possible standard.

Most Emergency Departments are open 24 hours a day, 7 days a week. All will have resuscitation facilities for the critically ill, cubicles to see other sorts of patients, and access to investigations (such as blood tests and X-rays) to help make diagnoses.

If you have to visit an Emergency Department you can expect to be asked for your personal details, name, address etc and to be registered onto the computer system. You may be seen by a nurse briefly before seeing the doctor or nurse practitioner. This process is sometimes called “triage,” or sometimes called “assessment.” The idea is to find out who can best deal with your problem and in which part of the department, whether any treatment or investigations can be started, and whether you need to be very seen urgently. Sometimes you can be treated on the spot, or directed to a more appropriate service. Most Emergency Departments will allocate each patient a “triage category,” which indicates in which order patients should be seen, not necessarily how serious the problem is. This process also allows you to be given pain killers as soon as possible.

When you are seen by a doctor or nurse practitioner they will assess your condition, and decide on what the best treatment for your condition is including whether you need to be seen by a specialist or by your own GP after discharge. Sometimes patients can be treated and discharged, and some will need to be admitted to hospital. Many Emergency Departments have their own wards to which patients can be admitted for short periods of observation or treatment. You may also be referred to other hospital specialists for advice or treatment. This doesn’t mean that the Emergency Department doctors don’t know what they are doing, but that other specialists may be able to provide exactly the right care for your particular problem as well as providing follow up care to ensure your condition responds to the treatment.

Just because Emergency Departments have to see lots of patients doesn’t mean you should ever feel that things have not been properly dealt with, or that you don’t understand what is going on. If you visit an Emergency Department and feel like this, talk to the staff and ask them to explain things for you.

In England , the government has specified that 98% of patients should be seen, treated and either admitted or discharged within 4 hours of arriving in the Emergency Department. In general we believe this is a good thing and it has enabled us to improve care in many ways in our Emergency Departments. However,  this can occasionally result in you being  moved around the department or being sent to other facilities in the hospital. If you do feel that this has already affected your care, we would advise you to discuss it with the senior nurse or doctor in the department or write to the hospital managers after you are feeling better. The College of Emergency Medicine meets regularly with the Department of Health (DOH) and has always been clear that quality of care for patients must be the priority.