Response to Brooks, Sakr, and Dugdale
Thank you for giving me an opportunity to respond to the correspondence concerning my article on minor injury units .
Dugdale and Sakr make so many points that it is difficult to keep my response brief. However, neither of them deny my main concern which is that thousands of minor injury patients are being treated by nurses who had no nationally recognised training and who themselves decide what conditions they can deal with. This is an unsafe situation and in my article I have tried to explain why this is being tolerated by some A&E specialists.
I am well aware of the literature concerning emergency nurse practitioners and minor injury units in the UK. Most of these articles show only that ENPs can match the performance of doctors who have worked in A&E for just a few months. This is not an acceptable standard for either doctors or nurses who may practise without supervision eg in a minor injuries unit.
Also many of the articles are written by enthusiasts and convey an air of uncritical optimism. For example, I have yet to see a paper which explains what happens to those patients who do not fit into pre-agreed protocols.
In conclusion, our speciality should respond to the advent of ENPs and minor injury units in the same way as any other medical innovation. A strong evidence base is required and we must ensure that our patients are not put at risk.
A M Leaman
Consultant in A&E Medicine
Princess Royal Hospital
(1) Leaman A. The management of minor injuries - a personal view. Emergency Medicine Journal (Supplement) 2001 18 1 (2-3)