Editor,
We thank Dr Dorman and the RCGPNI Executive Team for their interest in our work and we are pleased to reply.
Dr Dorman rightly acknowledges that there is no internationally recognised definition of an Emergency Department (ED) inappropriate attendance. A recent survey of ED nurses, doctors and paramedics in three Irish hospitals identified a variety of definitions of inappropriate attendance, with variation within the different professional groups.1 It is possible that other healthcare practitioners may have disagreed with some of the assessments made by the small group undertaking our analysis of attendances.
We recognise the limitations associated with our review, including its small size and its retrospective nature, which, as we acknowledge in our paper, means that our analysis was limited by the comprehensiveness of the ED notes.
We would welcome further, larger studies into the appropriateness of ED attendances and the characteristics associated with ED attendance. Studies undertaken in other areas have provided some analysis of the determinants of ED use.2,3 However, despite the limitations which we have noted in our own analysis, we believe that it has given us some useful information on the proportions of attendees to EDs, within one Trust in Northern Ireland, who may have the potential to be seen safely in alternative settings.
Footnotes
UMJ is an open access publication of the Ulster Medical Society (http://www.ums.ac.uk).
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