Survey of casualty departments in Greater London.

A review of health professional attitudes and patient perceptions on ‘inappropriate’ accident and emergency attendances. The implications for current minor injury service provision in England and Wales

“…(1977 ) and Bellevia & Brown (1991) within the review, it could be concluded that ‘inappropriate’ patients receive less than half the dressings and injections required by ‘all’ attenders, indicating that injuries receiving this treatment are generally of greater severity. This observation is corroborated by results confirming that ‘all’ patients have higher admission rates (for example, Fairley & Hewett 1969, Williams 1984, Nguyen‐Van‐Tam & Baker 1992) than ‘inappropriate’ attenders, although little difference is observed between discharge rates. An interesting point which the review highlighted is that 3% of Fisher’s (1981) sample (13 patients) and 2% of Bellevia & Brown’s (1991) sample (four patients), classified as ‘walking wounded’ and hence ‘inappropriate’, were admitted.…”

The history and development of trauma and emergency care in England

“…As in the 1940s, in metropolitan areas many attendees came because it was either easier than arranging to see their GP, closer to their place of work or they felt they did not want to 'bother' their GP, not accounting for the additional 'floating population' who were away from their regular heath care provider. 15 The prospect of recruiting enough general practitioners to bridge the gap in services to adequate levels would require a streamlining of services, particularly in London where there was still a high number of departments all providing a similar but inadequate service.…”

Accident and emergency work: a review of some of the literature

“…The report by Fry (1960) refleds reports initiated by doctors, past and present A and E departments are viewed m terms of numbers and those attendmg are labeUed as 'good' or 'bad' In many reports the terms are implied rather than stated The publicahon of such reports has helped develop athtudes of the medical and assoaated professions toward the user of the A and E service People are seen m terms of their medical complaint or non-complamt as judged by the doctor (BlackweU 1962, Crombie 1959, Dixon & Moms 1971, Fry 1960, Fairley & Hewitt 1969, Lamont 1961, Rutherford 1975, WiUanson etal 1977) Fry (1960 outbnes possible funchons of a casualty department, viewing it as bemg available for speafic reasons, to deal with trauma, emergenaes, mmor surgery, medical and surgical problems Agam, this is evident withm the modem A and E debate (Irvmg 1989, Tubbs 1989, Chorlton 1990, Templeton 1990 Other issues such as centralization and the reduction m the nunJjer of A and E departments put forward by Fry (I960) are developed withm a number of government reports Two reports reviewed withm this work are the Nuffield Report (1960) and the Platt Report (1962) These are viewed as playmg a major part m the shapmg of current A and E services and all had a central theme relahng to the open-house pobcy…”

“…If correct, the emphasis on the open-house policy of the A and E department requires further review to establish the pereeptions of those attendmg but eonsidered to be rule breakers Geffery 1979) or inappropnate attenders (Blackwell 1962, Crombie 1959, Dixon & Moms 1971, Fairley & Hewitt 1969, Fry 1960, Green rfai 1991, Lamont 1961, Rutherford 1975, Warren 1989, Wiikmson et al 1977 Cabian (1983) recognizes that bttle attention has been paid to the decision making of patients attendmg A and E He links attendance at A and E to the lay refenal and diagnosis system and believes that attendance is more bkely if the injury oeeurs away from home More work sueh as this may be required before the open-house pobey IS eomprehensively analysed and workable reeommendahons put forward Assoaated issues and events takmg place withm the setting also require further examination Mannon J M (1976)…”