Phone screening plan for casualty patients

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The British Medical Association yesterday unveiled plans for a radical overhaul of hard-pressed hospital accident and emergency services, which includes a campaign to discourage the majority of patients from using them.

Doctors are to encourage patients to phone the hospital first and check that their problem is appropriate for A&E treatment. If not, the hospital should redirect the patient to the right department or to a GP.

Staff shortages and funding problems are at the heart of the A&E crisis, according to the BMA, but the expanding workload of non-emergency patients - minor injuries account for the largest volume of A&E patients - who would be better treated elsewhere is also significant.

Up to 40 per cent of patients who attend casualty departments should not be there, according to Dr Laurence Rocke, a consultant in A&E at the Royal Victoria Hospital in Belfast who chaired the BMA working party on A&E services.

The BMA said that a telephone system in which experienced staff advise patients where to go for treatment would reduce demand significantly.

In addition, the association is calling for the development of acute admissions units to cut trolley waits for patients admitted through A&E who need a bed elsewhere in the hospital. Such a unit would allow in-patient treatment to start more promptly, and many patients might be eligible for discharge direct from the unit, easing pressure on beds, the BMA report concludes.

James Johnson, chairman of the BMA consultants' committee, said: "We want to avert the regular winter crises in A&E by taking practical steps now to ease the pressure... Many people see A&E as the front door of the hospital, open to all comers. We need to make sure staff are concentrating their efforts on genuine accidents and emergencies, not acting as a clearing house for diagnostic tests."