This is an individual visit by one patient to a minor casualty unit to receive treatment from the accident and emergency service, which may be provided by staff from other specialties. Such attendances may be as a result of a request from a GP for help with a diagnosis or treatment.
New Attendance: the first visit made by a patient to a minor casualty unit for a particular injury or ailment.
This excludes attendances at a consultant clinic run in the accident and emergency department which are out-patient attendances.
Initial Assessment: The first assessment of the patient’s condition by medical or nursing staff to determine priority after the patient’s arrival at a minor casualty facility. The key point is that the patient must know that they have been individually assessed. Patients arriving by ambulance should be included; normally they will all be assessed immediately. A doctor or nurse should:
ask the patient about the problem
examine them
assess the priority for treatment
give any first aid treatment required; and
talk to the patient about what will happen to them while they are in the department
The guiding principle is that a patient should be clearly aware that they were clinically assessed immediately on arrival, in the common sense of the word, i.e. were not kept waiting and did not have to go through other "bureaucratic" procedures first in order to gain reassurance that their condition was to be treated appropriately.
Note: There can be a problem if arrival time is recorded at reception. The patient may have queued already, and registering at reception first could delay assessment from taking place immediately. Alternatives are for the assessing nurse or doctor to record arrival time (but there may still be problems with queuing), or to use automated or semi-automated methods. If monitoring is carried out by a dedicated observer i.e. someone who does not have to do a job at the same time or by asking patients, this problem does not arise. Registration could also be arranged after initial assessment.