Are you sure you’re in the right place?

By Ian Dipple Friday 07 March 2014 Updated: 07/03 11:57

SORE throats, insect stings and even a paper cut are just some of the reasons why people have turned up at the county’s Accident and Emergency departments.

Health bosses have released details of a number of cases where they say people could have been treated more appropriately by other parts of the NHS, to demonstrate how unnecessary attendances are putting pressure on the system.

They include people suffering with nose bleeds, back pain and even someone with just a temperature and a cough.

It is estimated about a fifth of people who turn up at A&E could be treated elsewhere. On last year’s attendances that’s a staggering 27,000 people.

Patients unnecessarily attending the county’s emergency departments is adding to the pressure they are already under as a result of an increasing number of emergency admissions, particularly of frail, elderly people with more complex conditions.

Worcestershire Acute Hospitals NHS Trust has missed the four hour A&E waiting target for four months running with just 87.88 per cent of people being treated, admitted or discharged within the time period in the first two weeks of February compared to a target of 95 per cent. There is a particular problem at the Worcestershire Royal which dipped to just above 81 per cent while it was just over 91 per cent at the Alexandra Hospital.

Part of the problem is patients are confused about what different parts of the healthcare system - such as Minor Injuries Units and pharmacists - can offer and so turn up at A&E by default. A special website www.isaandeforme.com has been set-up to try and guide people to the best place for the problem they have while a free mobile app Is A&E for me is also available to download.

Ruth Davoll, urgent care Lead for the Worcestershire’s three clinical commissioning groups, told the Standard: “It is important patients’ stop and think whether their injury or illness really requires attendance at A&E. Many health problems and minor complaints, as shown in the above cases can be solved with self-care or by visiting a local GP, MIU or pharmacy. Unnecessary trips to A&E not only put a strain on NHS resources but also put lives at risk.”

These are some examples of people who turned up at A&E who could have been treated elsewhere and where they should have gone:

Case 1 - A middle aged lady with back pain. She has had the pain for several weeks but it is not getting better. The pain is worse when she moves. She does not have any numbness/pins and needles, no trouble with her “waterworks” and is otherwise well.

Where should she have gone? She does not need to be seen by anyone immediately and will get good advice about alleviating symptoms and how to manage her problem from her GP.

Case 2 - A 25-year-old woman with an insect bite from two days ago. She has a swollen arm and says she always has antibiotics because the bites always swell. She is well in herself with no rash elsewhere, no fever and no breathing difficulties.

Where should she have gone? Insect bites are very rarely infected and therefore do not normally require antibiotics. This girl is almost certainly just having a local allergic reaction. They do not require emergency treatment and can get advice from a pharmacy, Minor Injuries Unit (MIU) or GP surgery. If they are having generalised symptoms ie difficulty breathing, feeling faint or collapse then an ambulance should be called.

Case 3 - Sports injuries. Many people think that any pain in a joint or muscle that is due to sport, needs to be seen in A&E e.g. – developing pain in the Achilles tendon whilst training for a marathon or pain/clicking/minor swelling of a knee joint that starts whilst playing squash.

Where should they have gone? Unless there is significant sudden trauma eg. falling off a horse etc, they can be seen and managed very appropriately by their own GP, or for more serious strains and sprains at the local MIU. An x-ray in the acute situation is rarely helpful and even if an x-ray is required the GPs have access to a walk in GP service, 9am to 4pm during the week with same day reporting.

Case 4 - A 45-year-old man with nose bleeds over the past few weeks. None have lasted more than 15 minutes and he is otherwise completely well.

Where should he have gone? Unless a nose bleed does not stop after 30 minutes or the person has a specific condition they do not require emergency treatment. Simple self-care advice is to pinch the soft part of the nose for ten minutes without letting go to see if it is still bleeding. If it stops but they’re still concerned they can visit their GP for referral to ENT out-patients, if the GP is not able to cauterise (close it off) themselves.

Case 5 - A 28-year-old man, feeling generally unwell for two days with a temperature and a cough.

Where should he have gone? This is most likely a viral illness requiring regular fluids, paracetamol and rest. If they are usually fit and well, there is no rash, they are not having difficulty breathing and can keep fluids down then there is no need to be seen as an emergency. They should rest at home and take their GP or pharmacist’s advice.

Case 6 - A 50-year-old woman with burning and stinging when passing urine. It started two hours ago and she has been to the toilet several times but is otherwise well.

Where should she have gone? This is likely to be a water infection that may require antibiotics but these can be obtained from speaking to the GP or out of hours GP service. Pharmacists can give advice on symptomatic relief in the meantime.

Case 7 - A 25-year-old man cut himself on the finger whilst clearing out some metal. It is a very small cut and no longer bleeding, the finger is working as usual. He attends the Emergency Department because unsure if he needs a tetanus injection.

Where should he have gone? Tetanus boosters are no longer given every ten years. Once the primary course of three injections has been completed two further boosters are required, these are usually given at age four years and 14 to 16 years. If these are complete then there is usually no requirement for a further tetanus injection. The GP has records of immunisations and the emergency department do not have routine access to this. The correct course of action is to ring the GP surgery for advice. Patients born prior to 1961 may not have appropriate cover and should check with their GP.

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