Primary care problems in patients attending a semi-rural accident and emergency unit: A prospective study

Abstract

Objective - To analyse the characteristics of patients attending a coastal resort accident and emergency (A&E) unit and com-pare use by summer visitors with use by the indigenous winter population by previously validated assessment criteria. Setting - Accident and emergency unit of a semi-rural coastal town district general hospital. Subjects - 3643 first attenders in the summer cohort and 2876 in the winter cohort. Methods - All patients attending the A&E unit over two 28 day periods in summer and winter 1995 were assessed prospectively in four categories by trained, experienced nurse assessors. Category 4 identified patients who fulfilled the King's College Hospital criteria as being suitable for care from primary care practitioners. Results - 43.8% of the summer patients could have been seen in the primary care setting, as could 38.7% of the winter visitors. Conclusions - The proportion of patients with primary care problems who attend semi-rural A&E units appears to be much higher than previously thought. These findings cast doubt on the validity of the King's College Hospital criteria for classifying patients to either primary care or A&E categories.