Accident and Emergency Claim

Is a Delay part of a Accident and Emergency Claim?

The answer is not straightforward. If your delay caused or contributed to an injury then yes. If your delay caused a very short period of extra pain or anxiety then probably no. Ultimately, in order to bring an action in clinical negligence and particulary as an accident and emergency claim. We have to be able to show that the Hospital failure was one that a reasonable body of similarly qualified Accident and Emergency practitioners would not support. If they made an error in triage and you were made to wait while your condition got worse then they are likely to have been negligent. This is going to be different for every patient and we would encourage you to call or otherwise contact us to clear this up.

Can you claim for a misdiagnosis in an Acccident and Emergency Claim?

Yes, however, again, it is rarely this simple. Just like any other claim a Solicitor in an accident and emergency claim has to prove that misdiagnosis was unreasonable and unsupportable, they then have to show that the result of it was an injury of some degree. In short though, misdiagnosis is often a breach of duty and is more prevalent in the pressurised environment of the emergency department than it is almost anywhere else in the hospital.

If there is a failure to refer is that a Accident and Emergency Claim?

Yes, in fact this is the second largest group of failures from the emergency department. It is always a matter of interpretation however, accident and emergency are presented with the facts of your injury, they will take a clinical history and they will perform an examination. From these things, they will draw a conclusion. If they consider there is no further action to take, they will discharge you. If they are wrong and sometimes they are; the results for a patient can be catastrophic.

The first port of call for the emergency department is usually a section marked as “triage”. This is an area set aside for ensuring that the most urgent cases are dealt with first. That can mean that non urgent cases have a very long wait but with limited resources, that is inevitable.

The  tools available to the Triage team typically identify patients in five categories: (1) Resuscitation, those needing immediate lifesaving interventions; (2) Emergency, those who need significant intervention that cannot be delayed; (3) Urgent, those needing treatment but for whom a degree of delay could be tolerated, (4) Semi Urgent, those who are in requirement for treatment but delay can be endured. Level 5) is for non urgent patients who require little or no treatment.

This process of triage is relentless and intense work. Typically a registered nurse will begin by taking a history from the patient, perhaps also a brief examination. S/he will assess the siutation based on the categories mentioned above. It will come as no surprise that very few Cat 1 patients are missed or mislabeled. It can happen but rarely. Similarly Cat 2 are typically identifiable with very little effort. The issues for clinical negligence and an accident and emergency claim tend to appear between levels 3 and 4.

Post triage, the patient should be registered, treated (frequently allocated elsewhere in hospital) and then re-evaluated. Once the situation has stabilised and no further treatment is necessary the patient can be discharged (usually with instructions).

What is the difference between an Accident and Emergency Claim – and a Casualty or Emergency Department Claim?

Casualty Department

The original term (casualty) meant a seriously injured patient. It was a military word in general use as a term for the wounded. The casualty ward also occurred in Shakespeare, and Dickens writing in 1837 to describe the hospital ward in which accidents were treated.  In 1869, the outpatients department in St Bartholomew’s (Barts) was divided into two categories.

The first was “Casualty”, which included immediate attention for all requiring treatment for diseases or injuries. Secondly there was the “Outpatient” who, after receiving a letter of admission, was entitled to the advice of the assistant surgeons and physicians for a period of two months. In the Royal Free and Great Northern Hospitals the casualty cases were attended to by the house surgeon.

A&E, Accident Units, and Emergency Departments

In 1935 the British Medical Association produced a report on fractures. It pointed out the deficiencies in the process for dealing with patients. There was lack of organisation and little or no continuity of care. Patients were admitted under the charge of a surgeon who variously took little interest in cases with no surgical input or in some cases sought to intervene only when they did. Typically this work was reffered out to medical students or even abandoned to ward nurses.

The recommendations were that a “casualty officer” should examine patients with ambulatory fractures. A “chief assistant” then would see patients the next day in the daily clinic. Inpatients fractures admitted through casualty or outpatients would be seen by the house surgeons if uncomplicated. Complicated and compound fractures were to be dealt with as emergencies. Later in 1943 The British Orthopedic Association in its Memorandum on Accident Services emphasised that accident services of the future should embrace the treatment of fractures as well as soft tissue injuries, infections, and all other injuries of the loco motor system. They also believed that accident services must be developed by surgeons who have been trained and qualified to deal with trauma.

The Birmingham Accident Hospital was created in 1941. The hospital was established to deal with the rapidly increasing road traffic and industrial accidents. Within one year of its foundation the Birmingham Accident Hospital attracted the interest of the Medical Research Council under the direction of Sir Ashley Miles. Plans to extend these small “accident hospitals” nationally were put in place.

Rapidly following the establishment of the National Health Service in July 1948 every major hospital established a regional “accident clinic” that were part of a general hospital. Orthopedic surgeons were typically in charge as the loco motor system accounted for three quarters of all injuries. The 1961 Platt Report gave authority for the creation of regionally focused centres for acute medicine. They were called emergency clinics, Accident clinics, Accident and Emergency and Emergency Rooms variously across the country. The overall approach varied but the philosophy was exactly the same.

The Future of A&E

Emergency Departments are a signficant contributor to the NHS bill for negligence. IN most of these actions it is a Accident and Emergency Claim that is at the heart of the issue. However, Other countries, France and Germany for instance often do not have Accident and Emergency services – how do they cope. Well there is more of a focus on paramedic facilities and there is still a typically surgeon led assessment centre for major acute admissions.

There is no doubt that we do things differently however, A&E is part of the UK culture. It is so ingrained in our thinking that it is hard to imagine any Hospital in the UK without such a department. We do things differently and whilst it is true that errors occur, they are, given the huge number of treated patients that flow through Accident and Emergency – a tiny proportion of the overall number that are helped and assisted.

Accidents happen, the A&E department are not immune to them, however we should not shy away from bringing a legal action should that be necessary. ultimately we would bring an action if the accident happened anywhere else!