Patient diverts neither safe nor effective – Confirms new EMJ research


DIVERTING patients, who are ‘not seriously ill’, away from emergency departments is neither safe nor effective, new research published in the Emergency Medicine Journal (EMJ) yesterday has confirmed. The A&E divert system had to be ‘temporarily suspended’ earlier in the year after a patient died.

The ‘front-door streaming’ programme is currently ‘under review’. The scheme involves a GP posted at the front door of every A&E. When a patient enters the A&E, a GP assesses them and decides whether they should be seen in A&E or diverted back out of the door and told to see their local GP.

During the pilot in Bristol, David Birtwistle, 44, a father-of-one, died from a pulmonary embolism after being turned away, just six days after its launch. Instead of being seen by A&E doctors, he was seen by the GP service which failed to order basic tests which could have saved his life.

The new report in the EMJ concluded that ‘given the considerable costs of providing alternative sources of care, there is remarkably little good quality evidence to back this approach’. It added: ‘At this time there is insufficient evidence to recommend the implementation of diversion protocols as effective and safe strategies to address emergency department overcrowding.’

Lead author, Dr Brian Rowe, University of Alberta, isn’t convinced ‘the juice is worth the squeeze’. He said: ‘I am not sure the efforts involved in doing diversion are really worth all the costs, time, and surveillance.’

BMA member Anna Athow, commented: ‘Employing GPs at the front door of hospitals’ A&E departments is dangerous. Patients have already died and it is unsafe. It should be stopped immediately, together with all the other “streaming” tricks used recently to keep patients out of hospital, such as triage by clerks and nurses and diversion into urgent care centres at the front door.’

• Shrewsbury and Telford Hospital Trust (SaTH), which is already in special measures, has now been rated inadequate by the Care Quality Commission (CQC). Emergency and maternity services at its two hospitals were ‘deemed unsafe’.

The 112-page report, published yesterday, lists a catalogue of issues at the Royal Shrewsbury Hospital and Princess Royal Hospital in Telford, Shropshire.