Review of a consecutive series of the elderly patients who presented unheralded to the Accident and Emergency Department of the Royal Gwent Hospital showed that a relative minority (11%) were difficult to manage because they had no obvious acute medical condition or injury which qualified them for admission by the firms to whom they were first referred. The difficulty was compounded by the shortage of geriatric beds. Judicious use of short-stay ward beds in the accident and emergency department relieved pressure on beds elsewhere and allowed a short space of time in which preparation could be made for the patient's further care in the community. Elderly patients were removed quickly from the stretcher area of the accident and emergency department to the quieter surroundings of the short-stay ward, where their immediate nursing requirements could be readily met. It was not then necessary for them to be on a trolley for hours while junior doctors haggled on the telephone or nurses were too busy to administer food, drink and bedpans.
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