Improving care in accident and emergency departments BMJ Volume 323, pp 39-42
A study in this week's BMJ finds that most care in accident and emergency departments in the United Kingdom is delivered by junior medical staff, often in their first post-registration job. As a result, many patients attending these departments could be managed better.
Researchers at Derriford Hospital in Plymouth analysed 56 studies published between 1996 and 2000 that were critical of accident and emergency care in the UK. Problems were found in 35 different areas. Doctors bore the criticism in about half of the studies. Other criticisms were directed at various aspects of service provision, and almost all the studies made some recommendations for improvement.
The authors conclude that more middle and senior grade doctors are needed to improve the standard of care. This would allow more experienced doctors to participate in the care of most or all patients and would also allow junior staff to spend an introductory period shadowing a more experienced doctor, before starting clinical work.
The UK government believes that there must be a "guarantee of excellence for all patients." Most doctors would agree with this aim, but the cost must be acknowledged, write the authors. An excellent service is not achievable when an emergency department is staffed mainly by senior house officers, they add.
Contact: Lee Wallis, Accident and Emergency Department, Derriford Hospital, Plymouth, UK