ANALYSIS OF TELEPHONE CALLS TO AN INNER-CITY ACCIDENT AND EMERGENCY DEPARTMENT

The general public in the UK often telephone accident and emergency (A &E) departments for medical advice. Such calls are usually dealt with by nursing staff in an informal manner (often with no written record o f the call being made). The specific questions addressed in this study are who was calling for advice, when did they call, what were their p resenting complaints, and what was the outcome of the call? In additio n, the study provided an opportunity to test the implementation of a n ew system of record-keeping for telephone consultation. A telephone co nsultation record (TCR) was developed and used to record details of ea ch call made to the A&E department for medical/health advice. An analy sis of 597 consecutive documented calls is presented in this paper. Th e majority of calls were dealt with by 'E' grade nursing staff (42.7%) ; only four calls (0.7%) were recorded by medical staff. Two hundred a nd six (43.5%) calls related to patients aged up to 15 years. In 57% o f the cases the call was made by a third party. In all, 149 different presenting complaints were recorded on the TCRs. The three most common presenting complaints were dental problems (7.4%), fever (4.3%), and concerns about drug reactions (23%). Seventy-three per cent of callers were advised that a visit to the A&E department was not immediately n ecessary. The study identifies several important issues for developmen t of a more formal and effective system of telephone advice. The major ity of calls made to the A&E department appeared to be of a primary ca re nature but the extent to which nurses are trained to assess and adv ise on these problems needs to be questioned. A reluctance to document the calls to A&E was identified, one reason being a concern about acc ountability. Training and support are clearly required.