How prepared is your A&E

I was reading some of the work of Professor Enrique Casalino in Paris. Last year he noted that the number of patients attending his A&E had increased by 10%. On January 1st 2017 he noted that the average attendance had risen from 215 to 231 and the number of admissions from 25-35 a day to 30-40a day. He points out that this is an additional 5 to 10 admissions a day and this small increase puts the hospital into a precarious balance.

“The problem comes from the tension on the availability of hospital beds downstream of emergencies.”

I believe that is a problem faced all around the world and particularly in the UK. Pauline Philip, the National Director for Urgent and Emergency care believes that we need to free up more than 3,000 beds this winter and the government have responded by providing £350mto NHS trusts to help them cope with increased pressure over winter.

So Professor Casalino tried something…..

There were 1,099 patients admitted to his A&E service during 2016/7 winter with the signs and symptoms of influenza. They all had nose and throat swabs which were run at the time and then stored. The medical records of 500 of these were examined by experts (A&E and infectious diseases) and nurses and physicians from the A&E performed a rapid antigen test on the samples. They compared the results of the rapid test to the results produced by laboratory based PCR tests. They concluded that there was no difference in test performance as well as confirming the feasibility of point of care testing in A&E.

He hypothesised that the use of an efficient rapid diagnostic test may result in changes in the management of patients by ED physicians and facilitates a reduction in hospital costs in adult and geriatric patients by limiting examinations and treatments in the ED and reducing the number of hospitalisations.

He developed a decision-tree model for his total population of patients. The implementation of rapid tests was associated with a reduction in costs when the prescription of standard care in A&E is limited to patients that are influenza positive and especially with a fall in admissions of 20% in Influenza negative patients and a fall of 10% in influenza positive patients. He estimated that compared to their usual care, the implementation of rapid antigen tests may produce a saving for his hospital of 1.7million euros.

What would you expect the prof to do now? That’s right he is implementing it. He is using new diagnostics to increase the efficiency of his A&E service and to save money.

What would you expect the NHS to do…………..



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