'Inappropriate' attenders at accident and emergency departments. II: Health service responses

Background. Health services have responded to perceived 'inappropriate' attenders at accident and emergency (A and E) departments in three ways. Firstly, they have responded by attempting to decrease the numbers of patients attending A and E departments. There is little evidence supporting the efficacy of such policies. Secondly, they have responded by referring inappropriate attenders to another site. Research indicates that whilst such referral may be feasible, resultant decreases in departmental workloads have yet to be demonstrated. Patient outcome has also to be determined. Thirdly, by performing triage of attenders they provide care appropriate to their needs. Sessional GPs working in A and E departments manage non-emergency A and E attenders safely and use fewer resources than do usual A and E staff. Long-term effects on health-seeking behaviour and patient perception of the distinction between primary care services have yet to be determined. Conclusions. Rather than vainly attempting to make the patients appropriate to the service, future initiatives should concentrate on making the A and E service more appropriate to the patient.