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Editor,—Following our previous paper published in March 1998,1 it is now five years since the unit became operational as a nurse led unit. The unit is open Monday to Friday from 0900 to 1700. During the five year period a total of 43 142 patients were attended to in the unit. Of these 32 755 were new patients, of which, 14 638 were children. A total of 3483 patients had fractures reviewed by the accident and emergency consultant during his biweekly sessions in the unit. The consultant continues to review all radiographs requested by the emergency nurse practitioner (ENP) and from the second year onwards only inspected one in every five patients' notes. Of the 9005 radiographs requested by the ENPs there have been 30 missed fractures and 78 false positive readings. Two written complaints were received, however neither of these pertained to the treatment given in the unit. One of the complaints concerned a child protection issue and the other concerned a mentally challenged child who was referred to Crawley Hospital for further assessment. In 1999 West Sussex Health Authority carried out a financial analysis of the service and it gave a cost per patient as £16.70 (this includes staffing costs but not overheads, for example, radiology). Thus the past five years gave further evidence that, with support, ENPs can provide a community with an effective and worthwhile service.
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