How does A&E work?

How does A&E work?

First of all. What is A&E (accident and emergency)? It includes:

• A&E departments – offering access 24 hours a day, 365 days a year – for emergency care of serious acute (recent) illness
• A&E staff – emergency medicine doctors, nurses, radiographers, reception staff, porters and healthcare assistants.

Medical and all staff are highly trained in all aspects of accident and emergency medicine.

So, what happens when you get to A&E, i.e. how does A&E work?

There are a maximum of four stages that we will now go through. Not all people need all 4 stages. In fact you may leave A&E after any of the stages.

1. Register at reception

If you arrive by ambulance – the ambulance crew will pass on your details to reception and hand you over to the nurses. If you are seriously ill, the staff will already know because the ambulance crew will have alerted them.

If you’re not in a life-threatening or serious condition, you will be prioritised by the A&E team along with other patients waiting to be seen.

Note. Arriving by ambulance does not necessarily mean you will be seen sooner than if you had walked in to A&E.

If you go to A&E – you will need to register when you arrive yourself. You will be asked a few questions such as name and address but also why you are visiting A&E. If you have been to that hospital before, the reception staff will also have access to your health records.

Once you have registered, you will be asked to wait until you are called for your first assessment, called ‘triage’ (below).

A&E-linked alternative services
If the receptionist feels your situation is not an accident or emergency, you may be sent to a nearby Urgent Treatment Centre (UTC), Minor Injury/Illness Unit (MIU) or referred to a GP on site. This will reduce the waiting queue in A&E and allow you to be treated more quickly, often under 2 hours from arrival. In some hospitals you can go straight there without registration at A&E reception. Find out.

The waiting time target for patients in A&E is currently set to be less 4 hours from arrival to admission, transfer or discharge. In reality it is often alot longer, even over 8 hours (so take something to read or do!). However, not all hospitals have a UTC or MIU on site, which means people with more minor (or long-term) problems will wait longer to be seen. So its worth checking on the hospital website what services they have before you go.

You may leave A&E at this point

2. First assessment – triage nurse

Once you have registered will be pre-assessed by a nurse before further actions are taken. This is called triage. It ensures people with the most serious conditions are seen first. Its main purposes are to assess:

• How ill your are – and the given a priority based on that
• The type of problem
• Do preliminary tests (e.g. blood and urine tests, ECG) that the person doing the second assessment needs
• Whether another to A&E would be better (you will be sent there if that is the case).

Again, if the triage nurse feels your situation is not an accident or emergency, you may be sent to a nearby Urgent Treatment Centre (UTC), Minor Injury/Illness Unit (MIU) or referred to a GP on site.

You may leave A&E at this point

3. Second assessment – A&E doctor, nurse or similar

This is when the decisions are made about your treatment and possible admission – i.e. what to do next.

It leads to one of five options:

1. No treatment and discharge
2. Treatment and discharge
3. Admission
4. Specialist doctor opinion and discharge
5. Specialist doctor opinion and admission.

Which of these happen depends on what the A&E health professional thinks is wrong with you, and the results of tests done at your triage.

It is hard to generalise. Sometimes further tests are requested by a specialist doctor (if their opinion is requested), before a course of action can be decided.

Again, if the health professional feels your situation is not an accident or emergency, you may be sent to a nearby Urgent Treatment Centre (UTC), Minor Injury/Illness Unit (MIU) or referred to a GP on site.

In some cases you may be sent home either with:

• No treatment – we do not give treatment unless its needed
• Treatment – i.e. you may be given a prescription (to get tablets from the hospital pharmacy) and sent home, or
• Asked to arrange a GP appointment.

Either way, the hospital will inform your GP that you have been to A&E.

You may leave A&E at this point

4. Possible admission (30% of cases) – sometimes after third assessment by specialist doctor

If your situation is more complicated, or you are more ill, the A&E doctor may:

• Admit you to a hospital bed
• Refer you to a specialist doctor. They will then see you and decide what to do. That will often lead to hospital admission under their care, to their ward. For example, this could happen for eye injuries, heart problems, strokes, major fractures, or if you need emergency surgery or gynaecology. The specialist doctor may send a few patients home and arrange to see them in their outpatient clinic soon.

You may leave A&E at this point

Special situations

Childrens’ A&Es

Some hospitals have a separate children’s A&E department where medical staff are specially trained to deal with children’s health issues. You may be asked to go straight to the children’s area where your child can be registered and assessed.  Or, in some hospitals, you can go straight there without registration at A&E reception. Find out.

Pregnancy

If you are pregnant ring the Labour Ward and/or Antenatal Clinic first. They will usually see you there rather than A&E. You will usually get better care there, as they are experts in pregnancy and its complications.

Waiting lists

You cannot use A&E to push you up a waiting list, if you are on one – either for an operation or procedure. Sorry.

Summary

We have described how does A&E work. We hope you understand it better now.