Abstract
Aim: The aim of this study was to evaluate the functioning of junior doctors working in accident and emergency (A&E) departments. Methods: The data of all patients treated by junior doctors at an A&E department over a 3-week period were collected. Diagnosis and treatment were verified on the basis of the outpatient diagnosis and treatment; patients who were discharged or referred to their general practitioner were asked to complete a standard questionnaire. The number of requests for laboratory or radiography investigations was also recorded, and patient satisfaction was evaluated. Results: Of the 1108 patients examined by junior A&E doctors, 791 (72 %) were also treated and discharged by these doctors. Laboratory and radiographic investigations were requested for 220 (20 %) and 492 (44 %) patients; of these investigations, 119 (54 %) and 206 (42 %) revealed abnormalities, respectively. In 1 % of patients the correct diagnosis was not established. Conclusions: The traditional junior A&E doctor is capable of treating patients or of referring them appropriately without making excessive use of diagnostic investigations. If the function of A&E doctors is to distinguish between patients who need specialist medical care or who can be treated in, and discharged from, the A&E department, then possibly these doctors do not require extensive specialist training.
Key words
accident and emergency (A&E) department - decision-making - referrals
References
-
1
Arnold J L.
International emergency medicine and the recent development of emergency medicine worldwide.
Ann Emerg Med.
1999;
33
97-103
-
2
Brunswick J E, Ilkhanipour K, Seaberg D C, McGill L.
Radiographic interpretation in the emergency department.
Am J Emerg Med.
1996;
14
364-368
-
3 Geloven A AW van. Spoedeisende hulp bij buikklachten. Evaluatie van het functioneren van de spoedeisende hulpafdeling aan de hand van patiënten met buikklachten. Universiteit van Amsterdam, Nederland 2000
-
4
IJzermans C J, Mentink S, Klaphake L MM, Grieken J JM van, Bindels P JE.
Contacten buiten kantooruren: klachten gepresenteerd aan de huisarts en aan de Spoedeisende Hulp.
Ned Tijdschr Geneeskd.
2002;
146
1413-1417
-
5
Jaarsma-van Leeuwen I, Hammacher E R, Hirsch R, Janssens M.
Patiënten zonder verwijzing op de afdeling Spoedeisende Hulp: patientkarakteristieken en motieven.
Ned Tijdschr Geneeskd.
2000;
144
428-431
-
6
Kooiman C G, Wetering B JM van de, Mast R C van der.
Clinical and demographic characteristics of emergency department patients in the Netherlands: a review of the literature and a preliminary study.
Am J Emerg Med.
1989;
7
632-638
-
7
Lufkin K C, Smith S W, Matticks C A, Brunette D D.
Radiologists' review of radiographs interpreted confidently by emergency physicians infrequently leads to changes in patient management.
Ann Emerg Med.
1998;
31
202-207
-
8
Netten P M, van der Zee P M, Bleeker M WP, Smulders C.
De eerste lijn voorbij.
Medisch Contact.
2002;
3
87-89
-
9
Richards P J, Tins B, Cherian R, Rae F, Dharmarajah R, Phair I C. et al .
The emergency department: an appropriate referral rate for radiography.
Clin Radiol.
2002;
57
753-758
-
10
Riet Y EA van, Schouw Y T van der, Werken C van der.
Minder rontgenfoto's en toch goede klinische zorg door geprotocolleerde fysische diagnostiek bij enkelletsels.
Ned Tijdschr Geneeskd.
2000;
144
224-228
-
11
Vries G MJ de, Luitse J SK.
Spoedeisende geneeskunde als specialisme. Drie modellen vergeleken.
Med Contact.
1999;
54
204-206
-
12
Vries G de, Zwartsenburg M.
SEH-artsen in Nederland: spoedeisende geneeskunde serieus genomen.
Triage.
2002;
5
12-15
Dr. F. C. Bakker
Department of Trauma Surgery · VU University Medical Center
P O Box 70 57
1007 MB Amsterdam
The Netherlands
Phone: +31/20/4 44 45 54
Fax: +31/20/4 44 02 74
Email: fc.bakker@vumc.nl
