Objective To determine the effect of a physician assistant (PA) working in a secondary care hospital emergency department (ED) on the overall performance of the ED.

Objective To determine whether changes to the appearance of an emergency department (ED) waiting room influenced the number of patients who left without being seen (LWBS).Design Retrospective analysis using National Ambulatory Care Reporting System data collected at the time of patient registration. SettingThe ED of Belleville General Hospital, a mid-sized secondary care community hospital in Ontario with a catchment population of 125 000.

The aim of this study was to plan a temporary minor injury unit (MIU) in an urban centre, to cope with large numbers of minor casualties from a predicted mass gathering. Numerous minor injuries could potentially overwhelm the local accident and emergency (A&E) department. To prevent this, a temporary MIU was planned in the city centre, developed by a multidisciplinary team of staff from the base A&E department and the more central hosting hospital, plus police and ambulance services. Issues involved included: identification of premises; training personnel; development of clinical protocols; determining equipment requirements; liaison with other departments; and public education. An electively closed ward was selected as a site. Two experienced doctors worked each shift, plus three local nursing staff directed by a senior A&E nurse. Joint training sessions were organized, promoting team cohesion. Clinical protocols, based on guidelines for a pre-existing MIU run by the A&E department, were augmented to recognize the increased capability available with the presence of medical staff. Equipment and drug requirements were dictated by these protocols. Planning was completed early to allow dissemination of information to the public. Despite this, the unit failed to have an impact on attendance to the main A&E department. Developing an MIU requires close coordination of numerous agencies and departments, plus adequate public education. Accurate predictions of casualties are needed to plan equipment and staffing levels, but can be difficult to determine.