A late shift in accident and emergency

The Accident and Emergency (A & E) department at Harrogate District Hospital in North Yorkshire, UK, serves a population of 142,000 in a catchment area that covers Harrogate, Knaresborough, Ripon, Nidderdale, part of Wetherby, and occasionally Ilkley and Otley. In 1994, 29,884 new patients attended the department, and 6760 return visits were made. There are large fluctuations in the workload of the department that are difficult to predict. This account of a late shift demonstrates particular problems that are associated with a split site hospital, the transfer of acutely ill and injured patients to specialised units, and how the nursing workforce is depleted by 25% if one nurse is absent due to sickness.