Journal of accident & emergency medicine
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Work was carried out to determine whether patients requiring emergency medical or surgical admission to hospital via accident and emergency (A&E) departments benefit from initial assessment by the ward senior house officer (SHO) as well as the A&E SHO. Two comparable consultant-led A&E departments sharing the same catchment population and receiving similar numbers of new patients each year were studied. A panel of four consultants audited the A&E notes and in-patient records of consecutive emergency medical and surgical patients admitted to two hospitals over the same 6 month period. ⋯ Diagnostic errors, inappropriate admissions to hospital and admission of patients to inappropriate wards were used as outcome measures. There was no significant difference in the rates of diagnostic error or inappropriate admissions between those patients seen by an A&E SHO only, and those seen in A&E by the A&E and ward SHOs. Detaining emergency medical and surgical patients in the A&E department for further assessment by ward SHOs does not alter inappropriate admission rate or improve diagnostic accuracy.
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A model is described for practising packing of the nose with ribbon gauze in the treatment of epistaxis. The model was constructed from accurate casts of a cadaveric nasal cavity. ⋯ After training on the model, there was a significant improvement in the confidence of the doctors to pack a nose, the amount of gauze packed and the visual appearance of the pack. Use of the model should raise the generally poor standard of nasal packing by doctors working in A&E departments.