What's a patient's 'journey' (yuck) through A&E?

Question

I have started a new job, in which I will be teaching clinical staff in A&E how to use the new software package the hospital has bought. The problem is, I do not have a medical background. I need a flowchart (or similar) to tell me what the patient's 'journey' is when they arrive in A&E. I hate the word 'journey' in this context, but I can't think of a better one. The point is, it's hard for me to train people on the new software when I don't really know what they're doing with the physical patient in front of them. What are the decision points? Some scenarios 1) Someone walks into A&E with a painful but non-critical injury, like a broken toe. What happens to them? 2) Someone arrives in an ambulance. What happens to them? 3) What are the other common scenarios I haven't thought of? For context, this is a large, NHS general hospital in a medium sized city, in England.

Answer 1

Note: Answering in terms of the US, but i believe the UK is similar.

In short, you will be triaged by a nurse, seen, and then leave the ER. You will either leave and go home, leave and go to a hospital ward, or leave to the morgue. The ER is a temporary landing zone for patients.

Everyone who enters an ER meets a triage team, whether they walked in or came by ambulance. I will comment on your specific scenarios...

1) Broken toe: He will be seen by the triage nurse, and then either assigned a bed or told to wait in the waiting room until one is available. Triage prioritizes patients based on their acuity. In this case, while he is probably in a lot of pain, he won't die, so he will be on the bottom of the list.

2) Ambulance: This depends on a lot of factors. The crew will call the ER while they are transporting to give a report to the triage nurse. If it is a high-risk complaint, such as chest pain, generally they will assign him a bed straight away and take care of the triaging and registration while doctors and other professionals work the patient up. If is is a non-serious complaint, the triage nurse will again prioritize based on the acuity. Yes, this means if the ER is full and the ambulance patient is stable, they may be placed in the waiting room. Contrary to popular belief, the ambulance is not a fast pass into the ER.

Once the patient is triaged and in a bed, the doctors and nurses will care for them. The attending ER physician will write orders (medications, treatments, imaging), and work to diagnose the patient's problem. Additionally, the attending doctor may consult with specialties, such as trauma surgery, psychiatric, cardiology, ect. From there, the doctor will decide the disposition of the patient. If the problem requires more intense treatment, they will be admitted to a ward. If the problem is relatively minor and can be treated by following up with doctors in their offices, the patient will be given the appropriate scripts, instructions to manage their illness/injury, follow up instructions, and be sent on their way.