Hospital admissions – theory and reality
Sir, – I was very disappointed to read the article regarding patient admission through the emergency departments (“30 per cent of admitted patients discharged within 24 hours ‘crazy’” , News, February 24th).
There are a number of reasons why it may be necessary to admit a patient for a short length of time, for example observations, further investigations or access to diagnostics that are not available 24/7.
The main reason is safety. This winter has seen record trolley numbers across the country, resulting in patients waiting up to 72 hours for a bed on the ward, so it is hard to understand how these “unnecessary admissions” are blocking access to ward beds if they do get sent home within 24 hours.
The notion that patients end up being admitted because of inexperienced doctors working in the emergency department are unable to make a decision is downright insulting.
Indeed, the emergency departments will discharge about 60 per cent to 70 per cent of patients who do present.
With better access to outpatient services, this figure could be higher.
If the senior doctors quoted in your article do honestly believe that the bed crisis could be helped by more senior decisionmakers in the emergency department, I will look forward to seeing them in the emergency department on my next night shift. – Yours, etc,
in Emergency Medicine,
Sir, – The implication that poorly trained young doctors admit patients overnight only for senior colleagues to discharge them on sight is misleading.
It fails to acknowledge how doctors are often forced to “play the system” in which they work, and how much information is often gained following admission.
Commonly, when a serious diagnos is suspected – a mild stroke, a tumour, or a vascular anomaly, say – the outpatient waiting time for the relevant diagnostic tests will run into months, or even years. If admitted, the tests will be done that day, and so when seen by their senior colleague, the results are available.
If serious pathology is ruled out, they are discharged and reassured, though perhaps left feeling they were admitted unnecessarily.
As absurd as it sounds, the patient or young doctor (quite unknowingly) holds the bed almost as a hostage, until the test is done.
Trainee doctors are often very smart, and many will tolerate the slight “loss of face” – wherein it is assumed they just lack expertise – in order to get the patient’s status cleared up as quickly as possible.
Our litigious society makes this approach wise, and perhaps mandatory.
And when our doctors move abroad, they take a different approach, since tests are available in a timely manner. – Yours, etc,