Patients who attend two accident and emergency departments

Forty-six patients were identified who attended an accident and emergency (A&E) department having previously attended a different A&E department in the same city for the same problem. Of these patients, 20% had been referred to the second department by the general practitioner (GP) or practice nurse. A diagnostic error had been made in 17.5% of patients at their first visit and some management errors were discovered. Eleven per cent of patients had an unnecessary second set of radiographs taken. A review of unplanned reattenders to an A&E department is an important opportunity for audit and normally an error will not be discovered if a patient attends a different department. We recommend that in cities where there is more than one A&E department a system should be set up whereby if a patient attends one department having previously attended another, the first department should be informed of the patients reattendance, especially if any diagnostic or management error has been discovered. Patients should be educated that if they have sought medical help for any problem and the condition does not improve, then they should return to see the same doctor or A&E department for continuity of care and avoidance of unnecessary duplication of investigations including exposure to X-rays.