How safe is your A & E

This winter will be particularly difficult. Following a significant increase in the number of cases of influenza in Australia NHS managers and politicians are worried. We already know that our A & E departments are full and many are failing to hit their 4 hour targets. When you walk through the ‘major’ section is usually full with people waiting on beds and trolleys waiting for the hospital to find them a bed.

I worry about the staff. Despite a valiant effort there will still be a significant number of members of NHS staff who have not been vaccinated. Having said this, we cannot be absolutely sure that the immunisation we have will be as effective against predominant strains as we would have wished. The last thing a hospital wants is an outbreak in their staff.

I was reading an assessment of an A&E department in Paris. Over the last influenza season 21% of attendances had signs and symptoms compatible with influenza. When tested 36% of these actually did have influenza. Of course the rates were higher in older people and particularly those with at least one underlying medical condition. When you think about this approximately 8% of the attendances actually had influenza. That is about one in 12.

The scary bit is that they don’t know and they can’t put all 21% of their attendances into isolation. So while you are sitting in the crowded waiting room or worse still on a bed in the ‘majors’ one in 12 of those patients will have influenza.

There is a potential solution. The ambulance service and the hospital could use a rapid antigen influenza test. If you start with a product that is approved by the FDA (the US have very good standards) and it is CLIA waved (suitable for use by non-laboratory staff) then you can have a nose swab done and a result within 10-15 minutes.

The hospital would be able to isolate those patients with influenza very early in their route through the system. They could get fast tracked to appropriate treatment and kept isolated from the other patients. Hospital staff would be able to implement control of infection procedures to protect themselves and other patients.

In Paris they are changing. When you go into A&E with signs and symptoms compatible with influenza you will have to have a nose swab taken. It will help them use their precious isolation facilities better and accelerate their clinical decision making. It is actually going to save them money – lots of it.

If you want to be sure that fellow patients in the waiting room haven’t got influenza – I suggest you go to France.


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