Book Name: Oxford Handbook of Emergency Medicine (Oxford Medical Handbooks) 4th Edition
Author: Jonathan P. Wyatt, Robin N. Illingworth, Colin A. Graham, Kerstin Hogg
Publisher: Oxford University Press
ISBN-10, 13: 978-0199589562,0199589569
Year: 2012
Pages: 772 pages
Language: English
File size: 8 MB
File format: PDF,EPUB
The emergency department (ED) occupies a key position in terms of the interface between primary and secondary care. It has a high public profile. Many patients attend without referral, but some are referred by NHS Direct, minor injury units, general practitioners (GPs), and other medical practitioners. The ED manages patients with a huge variety of medical problems. Many of the patients who attend have painful and/or distressing disorders of recent origin. A principal focus of the ED is to provide immediate resuscitation for patients who present with emergency conditions. In terms of sheer numbers, more patients attend with minor conditions and injuries, often presenting quite a challenge for them to be seen and treated in a timely fashion. Different departments have systems to suit their own particular needs, but most have a resuscitation room, an area for patients on trolleys, and an area for ambulant patients with less serious problems or injuries.
Paediatric patients are seen in a separate area from adults. In addition, every ED requires facilities for applying casts, exploring and suturing wounds, obtaining X-rays, and examining patients with eye problems. As the delivery of emergency care continues to develop, patients with emergency problems are now receiving assessment and treatment in a variety of settings. These include minor injury units, acute medical assessment units and walk-in centers. Traditional distinctions between emergency medicine, acute medicine, and primary care have become blurred. It is impossible to over-emphasize the importance of note keeping. Doctors and nurse practitioners each treat hundreds of patients every month. With the passage of time, it is impossible to remember all aspects relating to these cases, yet it may be necessary to give evidence in court about them years after the event. The only reference will be the notes made much earlier. Medicolegally, the ED record is the prime source of evidence in negligence cases. If the notes are deficient, it may not be feasible to defend a claim even if negligence has not occurred. A court may consider that the standard of the notes reflects the general standard of care. Sloppy, illegible, or incomplete notes reflect badly on the individual. In contrast, if notes are neat, legible, appropriate, and detailed, those reviewing the case will naturally expect the general standards of care, in terms of history taking, examination, and level of knowledge, to be competent. The Data Protection and Access to Medical Records Acts give patients right of access to their medical notes. Remember, whenever writing notes, that the patient may in the future read exactly what has been written.
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