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A & E Care Admission or not admission?

Can anyone answer this question are these following two admissions or not?

. I have been to to 3 times twice in November and once last month. First time no wrist bands, second time wrist bands, third time no wrist bands but was definitely admitted as release with asthma plan. Two on a Sunday and one on a Friday night hence A & E (classified as walk in where I live).

First one after I resolved myself with Ventolin then went to A & E to be checked out. (I was on prednisolone but still had an asthma attack) Bloods taken, ECg sats done.

Second time 2 days later Asthma attack couldn't resolve after 10 lots of Ventolin no ambulance but resolved after another 4 puffs at home. Another trip to A &E Again bloods taken, and Sats done. (wrist bands)

So yes or no admission or not.

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I am wondering why it matters?

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Its just I want to be clear for my records before my consultant appointment next month.

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I myself only count admission if im sent to a ward which usually involves an overnight stay. I have technically been admitted to a n e but released same day. When drs ask how many hospital admissions ive had i usually only count ones where i have been transferred to a ward.

Hope this helps

Mel x

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I think so. What is technically admitted?

I have been in hospital once before for a burst appendix so operation and a week stay in ward. So naturally would have had wrist bands.

The second one I had bands and I think it maybe because of a second time at causlty in two days. So some concern I was getting really bad with my asthma. The doctor treating me said I should consider asking if I could be under consultant care. I did request via my GPs to be refer to respiratory hot clinic the next day. Then saw the consultant the day after that.

Third time the nurses looked at me very puzzled as I didn't have bands. I never asked why they looked at me that way. I had been seen by doctor was having treatment and had been there from 2:30 pm on wards. (I got out at 6pm after doctor was happy to let me go).

So you can see why I wondering?

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When i say technically admitted its where ive been given a wrist band and told i have to stay. If im out the same day though i dont tend to count it but thats just me!

I was in a n e last week was there for about 4 hours but didnt count it. Hope that helps!

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I only count as an admission if 'referred to medics' ie acute medical team not A&E - though there are grey areas here. A year ago I was kept overnight in A&E to see what happened, but not referred to medics, and I decided not to count that as an admission (I had a motive, I was filling out a life insurance form and felt their definition wouldn't call that admission but since I had 4 more definite admissions in the same period it really didn't make a difference lol, they still said no). I have also been kept overnight in an A&E cubicle but officially under the care of the medics, not A&E, then released in the morning. I decided that counted.

Wristbands I have found are not reliable as some places will slap a wristband on anyone they find in the waiting room (my local - they literally give you one at the front desk) or occasionally will forget to give you one until you're eating dinner on the ward (my other local). I don't assume that a wristband means I'm staying now or lack of one means I'm not. I have also been in a hospital where they had what they called MAU (medical admissions unit, not to be confused with their AMU (acute medical unit), which was actually a ward). This appeared to be a clever device to get round the 4-hour rule ie send people there then decide what to do with them. It is a kind of limbo but while I personally never escaped from it without an admission, and I think they were just using it while waiting for a bed, I did see people sent home from there and if I had been, I would not have counted it.

Into A&E then home without being referred to anyone I would not count as an admission and neither would at least 2 insurance companies.

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In 2016 when I spent four days in hospital, I was admitted straight from the GP to what they called AMU or medical admissions unit, completely by-passing A&E. Both names were used for the same unit, so clearly even that varies! (And it confused me, I could not get medical admissions unit to be shortened to AMU). Anyway, all but me were either discharged or moved on to a proper ward within 24 hours. Some people there sat on a chair by a bed for several hours, until they received results back from some test or other, whereas others were clearly very ill indeed. It was like spending time in the middle of Piccadilly Circus! Things constantly on the go, especially in the night.

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I have been to hospital multiple times over the years. Sometimes I managed to get better after a couple of nebs in a and e and sometimes I'm admitted to a ward. As far as counting admissions goes I only count stays on a ward as an admission. If I remain in A and E then I don't. My local hospital puts a wrist band on you as soon as you arrive so having a band isn't an admission as such.

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Thanks all for your input. My local A &E did confuse me which is why I am asking these questions. First you are triage by a nurse to see if they need to be seen by a doctor. Then if you are like me then you are led to a large room. In this large room is chairs for each patient in a cubicle with a curtain that is drawn for privacy or when the doctor sees you. The staff in this place has nurses assigned to a number of chairs. A central desk with nurses and other nurses working at another desk.

So you are seen and treated by a doctor and your sats etc maybe monitored by nurses. There is a 'ward sister' who I spoken to a few times. In fact she remembered told me that I was in a different chair last November. She says she can remember people from months or even years ago. I think she remembered me as we were talking about girl guiding (I am a brownie leader) and she had a daughter who had done it.

I know this isn't admission now but would like to know what this is? So you can see why I was confused.

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From the point of view of your asthma control, needing A&E even if you are not admitted is still a sign things are not optimised. To qualify for the new biologic drugs you need 4 or more exacerbations requiring oral steroids in the last year, for example. Doesn't require admission!

On the other hand, my specialist asthma nurse was looking at a clinical trial for me, but had to say

no because I have just had an overnight admission. He said A&E

treatment would have been ok but overnight within 3 months of starting

the trial was not (grrrr). So A&E only was seen as less risky than admission in this case, but that's in the context of a clinical trial for severe asthma - they assume the patients will be having a certain number of flares already or they wouldn't need the treatment. Clinical trials may look at all flares this way ie count A&E together with admissions and look at whether the drug reduces the number. Or they may 'grade' the flares eg count admission as severe and A&E as moderate but still want to reduce both types.

If you are well controlled you shouldn't even be needing your inhaler every day, never mind needing to go to A&E! I think you should tell your consultant just how many times you have been and what happened. They will want to know and to reduce how much you need A&E treatment.

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Hi Lysistrata thanks for your input on this matter. I sorry to hear that you are struggling at the moment. I hope and pray you get your asthma under control.

What you are talking about is going further than the original question I asked. I have already discuss appointments with consultant on another post I written on this forum. (see breathing tests)

Brief description on whats going with me. I did get referred to respiratory hot clinic and saw a consultant two days after my second visit to A &E last November. (One flare up in late October then asthma attack, then two more asthma attacks (while on prednsiolone the visits to A &E mention in original post).

The consultant took my down my history from first diagnosis by GP to what was happen then currently. He ordered a blood test for IGe and found to be very allergic to house dust mite. Decided also to send me for breathing test (spirometry, lung volume and gas transfer). Done last Tuesday and I will find out the result when I see my consultant on 20th March. I believe then he will be reviewing my inhalers and medication and possibility changing them or tweaking them.

I am very well controlled at the moment and have not needed Ventolin expect once after breathing test caused me to cough (irradiated my airways I think) Four puffs of Ventolin and I was fine.

Last asthma flare up (caused by cold) followed by attack was 4 wks ago (visit to A &E was because it was Sunday and they are my local WALK IN center). Treatment 7 days of prednsiolone and a tailoring down of Ventolin over the following days after attack. Peak flow very good nearly perfect 490 best 500. (been asked to keep a diary of peak flow before taking inhalers morning and night)

I hope and pray that the consultant will be able to help me keep my asthma under control. My asthma plays up in the autumn/winter and in the spring and summer I am completely symptom free.

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Sorry I got confused as above you mentioned that you wanted to have it straight for your.consultant appt, but looks like consultant is already on top of where you are and good that he is looking into it. I hope your next appt is productive too and you can get control.

Thanks.for your wishes for me - I generally am not controlled and not really expecting to be at this point, but keeping an eye on new developments in asthma research. I have the wrong sort of.asthma for the current drugs but there are more on the way.

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Hi sorry to hear that you’re a bit up and down atm.

I keep a record of when I attend hospital, but separate a&e from admittance or outpatient treatment. You’re only truly admitted if you get a discharge letter usually from a ward however receiving outpatient treatment can also get your discharge letter (sometimes). My advice is to keep them as separate records (dates/location) and record how long you’re in if you do get admitted - one night two nights etc. It keeps all eye on when youve had to attend and how bad you’ve been really gone in.

Wristband wise it could just be how busy they are in A&E or it could be how serious they feel condition is (or will develop to) so sometimes you may be tag, sometimes not it depends on how long they think you’re going to be in for. If it’s just for a checkup with the doctor you may not get one, but if you’re expecting some more treatment they will give you a tag because most the time you need to tag to get medication is normally so that they know your you rather than someone else!!!

Hope this helps and you start to stabilise soon x

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Hi Emma F91 Thanks for your post. I think the way you layout your records of what happened to you in terms of hospital etc is very good.

The wrist band thing did confuse me when they gave me them on my second visit in two days. That was in the afternoon so perhaps they were busy. I was in from lunchtime to teatime. Last time last month I was in 4hrs and sent home with an adult asthma discharge management plan. (Never given that before I think that was because I was having an asthma attack when I went there).

I am seeing my consultant in less 4 weeks for the result of breathing tests. So I hoping he can tweak my inhalers and I can go back to GP care. Also spring is on its way when my asthma doesn't bother me at all. So I believe things are looking up. :-)

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