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Com 66485457-66963820 15 16 CHAPTER 1 General approach Inappropriate attenders This is an emotive and ill-defined term. Depending upon the department, such patients could comprise 4–20% of attendances. The perception as to whether it is appropriate to go to an ED or attend a GP will vary between the patient, GP, and ED staff. Appropriateness is not simply related to the symptoms, diagnosis, or the time interval involved. It may not necessarily be related to the need for investigation. For example, not all patients who require an X-ray necessarily have to attend an ED.

Do I know what treatment is needed and have I got the skills needed? 8)? • If not, do they need to be reviewed in the ED or another specialist clinic? The wide spectrum of problems with which ED patients can present means that no individual can be expert in every possible condition. It is therefore as important to recognize and accept when you are out of your depth as it is to make decisions and treat patients whom you know you can manage. Seek help appropriately and do not just try to muddle through.

Initiatives include nurse practitioner minor injury units and hospital-based primary care services. Evaluations are underway but, to function effectively, such services require adequate funding and staffing. It can sometimes be difficult to deal with primary care problems in the ED. After an appropriate history and examination, it may be necessary to explain to patients that they will have to attend their own GP. This may need direct contact between the ED and the practice to facilitate this. Inappropriate referrals Sometimes, it may appear that another health professional (eg GP, emergency nurse practitioner, nurse at NHS Direct) has referred a patient to the ED inappropriately.

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