Patients taken to MIU and transferred by ambulance to A&E: case review
| Patient details | Patient within protocols for transportation to MIU? | Crew decision appropriate? | Transfer on to A&E appropriate? | Condition/outcome of patient adversely affected by initial conveyance to MIU? |
|---|---|---|---|---|
| 0323: 74 year old woman, fallen at home. Presented with pain and swelling in her right ankle, and was not weight bearing. A previous history of osteoporosis was recorded. | Both reviewers: yes | Both reviewers: yes | Both reviewers: yes, radiograph taken at the MIU revealed a bi-malleolar fracture with talar shift that would need internal fixation, therefore transfer to A&E was appropriate. | Both reviewers: no. This patient was treated at A&E then discharged home to attend fracture clinic as an outpatient. |
| 0358: 85 year old woman, fallen while crossing the road. She presented the ambulance crew with wounds to the face, hand, and knee, but was reluctant to divulge history details. | Both reviewers: yes | Both reviewers: yes, albeit the patient giving limited information hampered them | Both reviewers: yes, staff at MIU found it difficult to stem the arterial bleed from the hand wound; therefore transfer to A&E was appropriate. | Both reviewers: no. This patient was treated at A&E then discharged home for follow up by a district nurse. |
| 0576: 65 year old man who had slipped at home. He presented the ambulance crew with a wound to the head, but with no loss of consciousness. The patient refused A&E but was persuaded to seek some medical attention at MIU. | Medical opinion was divided whether this patient met the protocol for transportation to MIU | Reviewers did not agree on whether the crew decision to take the patient to MIU was appropriate. The subsequent admission by the patient of loss of consciousness for 15 minutes made one reviewer conclude that MIU was not appropriate. However, it was only at MIU that the loss of consciousness was discovered therefore the second reviewer concluded that MIU was appropriate in the face of patient reluctance to attend A&E. | Both reviewers: yes | Both reviewers: no. This patient was treated at A&E then discharged home for follow up by GP. |
| 0701: 67 year old woman who had fallen. She presented the ambulance crew with a suspected fracture of the wrist and insisted on attending MIU. | Both reviewers: yes | Both reviewers: yes | Both reviewers: yes, a radiograph taken at the MIU revealed a Colles fracture that needed manipulation; therefore transfer to A&E was appropriate. | Both reviewers: no. This patient was treated at A&E then discharged home to attend fracture clinic as an outpatient. |
| 0728: 86 year old woman who had fallen while getting off a bus. She presented the ambulance crew with a wound to the head. | Both reviewers: no, because she was elderly with pain in her hip and not weight bearing as well as having a head wound | One reviewer noted that the crew decision to take the patient to MIU was appropriate because it was very close. | Both reviewers: yes, staff at MIU treated the head wound but suspected a fractured neck of femur; therefore transfer to A&E was appropriate | Both reviewers: no. A radiograph taken at A&E revealed a fractured greater trochanter. This patient required physiotherapy and was admitted to an orthopaedic ward. |
| 0731:89 year old woman who had tripped and fallen at home. She presented the ambulance crew with bruising of the forehead and neck and arm pain, and insisted on attending MIU. | Both reviewers: no | Both reviewers: yes, the crew had no choice other than taking the patient to MIU because the patient insisted on that | Both reviewers: yes, transfer to A&E was appropriate due to the nature of the injuries. | Both reviewers: no. This patient was treated at A&E and discharged home. |
| 0884: 73 year old woman who had vomited after a train journey. She was reluctant to attend A&E. | Both reviewers: no | Both reviewers: yes, the ambulance crew decision to take the patient to MIU was a compromise because of the reluctance to attend A&E. | Both reviewers: yes, the nature of the condition meant that transfer to A&E was appropriate. | Both reviewers: no. This patient underwent investigations at A&E but did not wait for results and self discharged against medical advice. |