Functioning of A&E Doctors: Baseline Measurement in a Dutch University Hospital

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

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