Links between systems in Accident & Emergency and primary care

The hospital emergency department and other elements of rapid access primary care constitute an emergency care network. Integration aims to maximise the network's strengths and overcome its weaknesses. Taking the patient as a starting point, it is possible to envisage an objective data model that can operate at multiple levels within the network to describe its process efficiency and clinical effectiveness. Other means of integration are also identified. These contain significant subjective elements. In particular, the decision support system of NHSDirect has operated successfully to legitimise national and local intervention based on skill-mix, whereas its technical operation has been susceptible to human deviation from prescribed routine. As we scrutinise a system, we discover that it contains people who are doing things. Logical elements in the system turn out to be givers or recipients of deliberate and thoughtful care. Information systems in Accident & Emergency (A&E) and primary care can help accountable planners to measure and control aspects of the network's operation. Clinicians also need their systems to enable, rather than constrain, effective interactions.