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Doctors and nurses in three accident & emergency (A&E) departments were interviewed about the feasibility of screening for hazardous drinking as well as the provision of minimal or brief interventions. They were also asked about a more comprehensive approach to alcohol‐related problems that would involve liaising with other services. The feasibility of a comprehensive approach to excessive alcohol consumption is considered. Quantitative data revealed that computerised A&E records did not accurately portray the prevalence of alcohol‐related attendance.

As a human right, people need to arrive early at the hospitals when they are injured in traffic accidents. Both the mean and equality of the time of arriving at the hospital are important. This study aimed to investigate inequality in arrival time of emergent traffic accident patients to the hospital in 2018–2019 in a city in the North of Iran.

The authors extracted the data from the Guilan province trauma system databank in Poursina Hospital in Rasht in 2018 and 2019. The Gini coefficient was used to calculate inequality, and a regression model was estimated for determining the reason for inequality in time to receive hospital services.

The study showed that patients’ arrival time from the time of the accident to the time of arrival to the hospital was 64.48 ± 47.63 min (minimum of 9 min and maximum 462 min). Gini coefficient was 0.31 (p <0.001), which does not show high inequality. Regression results showed that the transfer time of patients by car was 40 min longer (p-value <0.001) than ambulances (p = 0.036). In children, the transfer time was 42 min less (p = 0.003). Other variables did not explain the inequality (p > 0.05).

According to the time of arrival of patients and Gini index, in Rasht, inequality in providing services is not in a bad condition. This indicates that the emergency department does not systematically transport people to the hospital late.

Accidents are the most common cause of death to children over the age of one year. Pre‐school children are at particular risk and account for 30 percent of child attendances following an accident at Hull Royal Infirmary Accident and Emergency Department. With children spending more time outside the home at pre‐schools, playgroups and nurseries there is a need to ensure that accident prevention and safety remains high on their agenda. This paper details the development of the Focus on Safety award scheme developed by a multi‐agency group in Hull. Participating groups are asked to consider their own health and safety policies and how they promote accident prevention to both children and their parents / carers. The pilot of the Award Scheme showed that it was very popular with nurseries, pre‐schools and playgroups and that it was meeting a definite need.

Accident and Emergency (A&E) departments are increasingly popular venues for primary care, causing a serious threat to healthcare quality. This paper reports the development of a comprehensive research method for identifying primary care patients attending A&E. Patients were randomly selected from the four A&E departments across different time periods and different regions in Hong Kong. The definition of GP cases was based on a retrospective record review conducted by a panel of emergency physicians using the standard laid down by the Hong Kong College of Family Physicians. The patients sampled were similar in sex and age distribution to A&E attendees for the whole territory. The level of GP cases was found to be 57 per cent, with a significantly higher proportion of patients in the younger age group. The high level of use reflects the lack of a well co‐ordinated development of primary care services and interfacing with secondary care.

Provides an analysis of the innovation process in order to understand its development and to provide those responsible for its management with knowledge about this subject, as well as the behaviours that make it easy to introduce innovation successfully. The exploratory research work was carried out within the framework of a hospital’s accident and emergency department and the development of several cases of innovation was monitored in situ. Observes that not all innovations develop following the same pattern, but rather each one is determined by the radical nature of the innovation.

The purpose of this trial was to establish whether a change in the X‐ray referral procedure would reduce the time between presentation and admission for patients who attended a busy Accident and Emergency department with a fractured neck of femur. This group of patients was selected because they are susceptible to decubitus ulcers, the development of which may relate to the time spent on a trolley. Senior nurses in the Accident and Emergency department were educated in patient assessment and management, and knowledge and implementation of ionising radiation regulations. They then referred patients who presented with suspected fractures of the femoral neck to the radiology department within agreed guidelines and without a doctor's examination. Records were kept over a 3‐month trial period. A total of 27 completed cases were recorded and the data included radiological findings, total time from presentation to arrival on the ward or discharge, total time waiting for a porter and being transported, total time spent in the radiology department, and whether the patient reattended for a further X‐ray examination. We concluded that the change in X‐ray referral procedure resulted in an appreciable reduction in the overall time between presentation and admission. However, it was not possible to draw any valid conclusions regarding any reduction in decubitus ulceration as a result of this speedier diagnosis and admission.

Seeks to identify physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system. Details a descriptive, qualitative study, with semi‐structured individual interviews of 21 physicians in the Accident and Emergency Department of South Stockholm General Hospital. Identifies four descriptive categories for possibilities and obstacles. Concludes that gaining access to patient drug history enables physicians to carry out work in a professional way – a need the computerised prescription support system was not developed for and thus cannot fulfil. Alerts and producer‐independent drug information are valuable in reducing workload. However, technical prerequisites form the base for a successful implementation. Time must be given to adapt to new ways of working.

To analyse the implementation of fast‐tracking pathway of hip fractures from accident and emergency to the orthopaedic wards.

A retrospective audit analysing 100 case notes of fast‐tracked hip fractures selected at random for the period of one year was undertaken.

Several deficiencies were identified in the implementation of the pathway.

Recommendations have been made for correction of the inadequacies identified.

This paper aims to increase the efficiency and safety of fast‐tracking system for hip fractures, which is being deployed by many hospitals throughout the UK.

To formulate an effective teaching prog ramme in the principles of clinical effectiveness for junior doctors, with simultaneous participation in a clinical audit project during their six‐month period of employment.

Accident and Emergency (A&E) Senior House Officers (SHOs) were educated in the principles of clinical effectiveness through a structured five‐session approach whilst they concurrently performed their clinical audit project. Throughout the process the A&E SHOs were supported by the Clinical Effectiveness Unit and the A&E Consultant overseeing departmental audit.

The structured teaching programme resulted in a good understanding of the clinical effectiveness process amongst the A&E SHOs, as demonstrated by their ability to perform a clinical audit project which ultimately improved practice.

This study has involved the construction and assessment of a teaching framework for junior doctors. The conclusions have been drawn on the basis of objective measures such as the completion of a clinical audit project which successfully improved practice. Thus, the publications of the findings may be considered in the category of a research paper. However, the authors accept that the assessment of a teaching programme's success and its portability to other departments or institutions can be highly subjective.

With appropriate guidance and support, junior doctors are able to perform meaningful clinical effectiveness exercises at an early stage in their careers and within the constraints of short periods of employment. The structured teaching approach could be considered as a template which other institutions may wish to adopt to educate their own juniors.

Despite the increasing importance of clinical audit in modern practice, the authors are not aware of any published teaching programmes which provide junior doctors with the necessary understanding of and skills required to take part in the clinical effectiveness process.

The purpose of this paper is to explore the extent of compliance of commissioners and providers of hospital services in England with their duty under equalities legislation to be aware of patients with intellectual disabilities as a first step to making appropriate provision for their consequent specific needs.

National survey of healthcare commissioners undertaken as part of an annual learning disabilities services audit.

In total, 41.4 per cent of local areas were unable to supply information about numbers of people with intellectual disabilities among those admitted to hospital, 46.7 and 48 per cent, respectively, could not supply this information about out-patient and accident and emergency department attenders. Figures supplied by those able to provide data varied very substantially and overall were so low as to suggest considerable numbers had been missed.

The study is testing what local health commissioners are able to find out from hospitals. The authors do not know the accuracy of the data they reported.

The study suggests approaching half of healthcare commissioners in England have little or no information about the extent of proper adjustment of hospital care for people with intellectual disability in their area. Their responsibility to assure this has been repeatedly asserted by government.

The study indicates a need for more work to improve hospital care for people with intellectual disabilities.

This was a government sponsored national study to which local healthcare commissioners were expected to contribute.