J. Dale et al., PRIMARY-CARE IN THE ACCIDENT AND EMERGENCY DEPARTMENT .1. PROSPECTIVEIDENTIFICATION OF PATIENTS, BMJ. British medical journal, 311(7002), 1995, pp. 423-426
Objective-To compare patient characteristics and consultation activiti
es for attenders at accident and emergency departments assessed by nur
se triage as presenting with ''primary care'' or ''accident and emerge
ncy'' type problems. Design-One year prospective study. Setting-A busy
, inner city accident and emergency department in south London. Subjec
ts-Of the 5658 patients treated for new problems during a stratified r
andom sample of 204 three hour sessions between 10 am and 9 pm during
June 1989 to May 1990, all ''primary care'' (2065 patients) and a 10%
random sample of ''accident and emergency'' (298 patients) were includ
ed in the analysis. Main outcome measures-Patient's age, sex, duration
of presenting problem, diagnosis, laboratory and radiographic investi
gations, treatments, and referrals. Results-40.9% of attenders with ne
w problems were classified by triage as presenting with ''primary care
'' problems (95% confidence interval 39.6% to 42.2%). Primary care att
enders were more likely than accident and emergency patients to be you
ng adults, to have symptoms with a duration of longer than 24 hours, a
nd to present problems not related to injury (all P<0.001). Accident a
nd emergency patients were considerably more likely to be referred to
on call teams and to be admitted. Even so, 9.7% of primary care patien
ts were referred to on call teams and a further 8.9% were referred to
the fracture clinic or advised to return to the accident and emergency
department for follow up. Conclusion-Accident and emergency triage ca
n be developed to identify patients with problems that are more Likely
to be of a primary care type, and these patients are less likely to r
eceive an investigation, minor surgical procedure, or referral. Many p
atients in this category, however, receive interventions likely to sup
port their decision to attend accident and emergency rather than gener
al practice. This may reflect limitations in the sensitivity of triage
practice or a clinical approach of junior medical staff that includes
a propensity to intervene.