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Improving the care of the seriously ill patient: the interface between the accident and emergency department and critical care areas
  1. Peter Nightingale
  1. Intensive Care Unit, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK (pnightingale@compuserve.com)

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    If you were suddenly taken ill with an acute medical condition where would you go, and who would you like to have treat you? In the UK, acutely ill patients are usually sent, taken, or self refer themselves to the nearest accident and emergency (A&E) department. There, in the current climate of healthcare provision, they will be attended to in an inconsistent manner.1

    Ignoring here the valuable contribution that nurses make in the A&E department and considering only medical care, ideally a consultant in A&E medicine will see the patient immediately. However, often it may be a trainee from one of the acute specialties, and only some hours later. It is possible that this variability in practice costs lives because of inexperience in appreciating how sick a patient is, despite a plethora of warning signs.

    Here I am dying of a hundred good symptoms.

    Alexander Pope, English poet 1688–1744.

    The initial treatment given by these on call trainees, as well as being delayed, may also be suboptimal, even though evidence is accumulating that early, and appropriate, treatment along physiological lines in the emergency room can have a long term positive effect on outcome.2

    How can this scenario be improved? The two key elements are education and …

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