Advice given to patients with epistaxis by A&E doctors

This study was devised to determine the proportion of patients with epistaxis seen in accident and emergency (A&E) departments and discharged with verbal/written advice, and to examine if this information affects re-attendance rates. A questionnaire was given to all A&E doctors probing their current practice regarding advice given to patients with epistaxis on discharge. The information was complemented with a case note audit of patients with epistaxis seen and discharged by A&E doctors over a 2 month period, which assessed the content and format of advice given and the number of re-attendances. The standard used stated that all patients discharged from A&E should be given both verbal and written advice regarding the prevention and management of further bleeds. The A&E doctors were then invited to a presentation on the management of epistaxis and the appropriate advice to give patients on discharge. Written advice leaflets on the prevention and management of further bleeds were placed in the A&E department and were accessible to doctors and patients. Case notes were re-audited over the following 2 month period. Verbal and written advice increased from 19% to 61% and 2% to 54% respectively. The number of re-attenders who had previously only seen A&E doctors was reduced from 11 (17%) in the first half to 5 (8%) in the second half of the cycle, representing a 9% reduction. We conclude that the provision of adequate verbal and written advice to patients with epistaxis may have an important role in the prevention of further bleeds and subsequent re-attendance to A&E departments.     

Critical analysis of the 4-hour A&E policys impact on elderly patients

Government evaluations of the 4-hour waiting time policy show an overall improvement in accident and emergency (A&E) waiting times. However, the audit results shadow the policy's impact on age groups, which make it difficult to determine the policy's impact on older people, who are the largest and most vulnerable service users. Literature suggests that the policy has benefited the younger populace more than the older user group, who experience difficulties in other areas of the health system, both upstream through inappropriate ward admissions, incomplete assessments, poor care, and bed-access blocks while being held in clinical decision units as well as downstream, where ambulance staff are managing stacked patients outside A&E departments, causing ambulance delays to more vulnerable older patients in communities. While patient flow through A&E has improved, the upstream-downstream effect has disrupted patient flow through the remaining health system and communities, which has resulted in increased dissatisfaction and poor care mainly among the elderly population. This article examines the problems experienced by the elderly in A&E prior to the policy's introduction and its subsequent impact on older people following implementation, in order to determine whether the policy has improved or further deteriorated care towards this group.