Key Clinical Message Subclavian artery aneurysms are uncommon and present a diagnostic dilemma. Our patient attended with life‐threatening rupture, requiring prompt management. However, lack of on‐site facilities and specialist input posed a logistical challenge. The patient was stable enough to allow an urgent transfer to a specialist unit for successful endovascular repair.

BackgroundLength of stay in A&E is inversely proportional to quality of care. Prolonged occupancy of A&E beds by patients that need care, more appropriately at a different facility causes exit block. This compromises care also to other patients waiting to be seen and further increases waiting times.ObjectiveThe primary aim was to determine the time of disposition in the patient group referred for further care to external sites and to compare it with the referring hospital A&E's waiting time in general.IntroductionThe present study was undertaken over 60 days, collecting data from a total of 10,603 patients who attended the A&E, amongst whom 117 patients were referred to an offsite specialty for further care.A retrospective observational study was undertaken to collect data from all patients referred to a specific specialty from a single A&E which is part of a multisite NHS trust with shared specialties at different hospitals. This data was collected for the period between 1/1/2016 and 29/02/2016. The waiting times for such patients was then compared with that of the average waiting time for this A&E.Materials and MethodsData was extracted from the symphony data analysis for the particular A&E over the mentioned time period. A list of patients referred offsite to a particular specialty was obtained. Waiting times for these patients were calculated as the time since registration till the time they left the department. The average waiting times for all patients who attended this A&E during the study interval was also obtained separately.Results: ObservationsDuring the study period a total of 10603 patients had attended this A&E of which 78.44% left the A&E within 4 hours. Of the remaining 21.56% who breached the 4 hour target time a disposition was achieved for a majority (12.37%) within 8 hours and only 4.32% stayed beyond 12 hours.A subset of 117 patients was identified during this same time period who were referred to another site for a specific specialty assessment. Of this group 96 patients (82.05%) occupied the A&E for more than 4 hours. Nearly one fourth (23.93%) of the referred patients remained in the A&E beyond 12 hours.ConclusionThe current study has found that the patient group that needs referral to external sites for specialty care has a markedly longer A&E waiting time compared to the A&E waiting times in general. Figure 1Waiting time comparison between all patients attending A&E and those referred offsite.Figure 2Percentage of patients plotted against their A&E waiting times, comparing total A&E attendances with a subset of patients referred offsite. Table 1Waiting times for patients attending A&E between 01/01/ 2016 and 29/02/2016Waiting times (hours)NumbersPercentage0–4831778.44%4–8131212.37%8–125164.87%>124584.32%Total10603100% Table 2Waiting time for patients referred offsite to a particular specialty between 01/01/ 2016 and 29/02/2016Waiting times (hours)NumbersPercentage0–42117.95%4–84538.46%8–122319.66%>122823.93%Total117100%