Ref. 29752-75THERE is no such thing as a typical day in casualty.

Everyone from doctors, nurses, cleaners and porters have to be prepared for whatever may be thrown at them, at any time of the day.

Who knows when someone might break their arm, or lose control of their car, or attempt to commit suicide?

The staff at the Great Western Hospital take all this in their stride, and last month their hard work paid off when they scored 100 per cent in their waiting times target.

When the Evening Advertiser was invited to the department, 54 patients had already been through the Accident and Emergency doors by 10am that day. Their complaints varied from chest pains and broken bones, to bleeding in pregnancy and an attempted overdose.

The department, which has eight doctors and 12 nurses, sees around 150 patients each day, with a further 30 who admitted to the Acute Assessment Unit, a kind of fast-track system following GP referrals.

But Ian Kendall, consultant in emergency medicine, said people are still going to casualty when a trip to the doctor would suffice.

He said: "Sunday is the busiest day of the week. People do more leisure activities so have more chance of injuring themselves.

"Also, a lot of people still don't realise that GPs are available on Sundays even if the surgeries are closed. Out of hours services should be used rather than coming straight into casualty.

"But we have seen some excellent improvements, which has had a good effect on waiting times."

The target is for all patients to be seen and treated within four hours of stepping through the casualty doors.

When improvements began in September last year as part of the Emergency Services Collaborative, staff were seeing 72 per cent of patients within the target times.

Jill Brewer, emergency services collaborative programme manager at GWH, acknowledged this was not a good start. "That figure was poor by all standards but it has been getting better and better. In January, the average was 85 per cent, in February 87 per cent, and March reached 89 per cent.

"Those that breach the target times are seen within five to six hours.

"Recent changes of increasing See and Treat has reduced the average waiting time over the last two weeks to 106 minutes. See and Treat involves a senior staff member waiting at the door who literally sees and treats the patient, reducing waiting times and taking pressure off other members of staff in casualty."

The discharge lounge was also cited as an important facility in the department's efficient running. It is staffed by at least one nurse and one nursing auxiliary, and houses 15 chairs where patients who are well enough to leave hospital but not well enough to go home without support can sit and wait for medication.

The resuscitation room is next door, allowing easy access to paramedics.

Four bays, which include one for children, are equipped with all the necessary medical apparatus, and a new ceiling mounted X-ray system, costing more than £46,000, reaches all areas.

The ward itself has 20 beds, although number 13 has been omitted for superstitious reasons. There is a designated chest pain assessment area for patients suffering conditions such as heart attacks.

The target here is that patients are seen, diagnosed and treated within 30 minutes treatment is a clot-busting drug, which costs around £700 per shot.

Some 250 people are seen with chest pains each month, of which around 20 need the drug. So far the hospital boasts a 100 per cent success record in administering this treatment.

Porter Dave Godsell, 38, ensures the smooth running of the department, transferring people from ward to ward.

He also has the important role of calming patients who face potentially frightening situations.

He said: "I enjoy meeting people on the ward. There's always variation in my job. It's not just moving people around. I try and put them at ease by talking to them too."

Electrician George McNee, from near Devizes, was in casualty when we visited after he fell on a shard of glass. Mr McNee, 45, who was being treated by nurse Sue Howell, said: "I was working in a dimly lit roof and put my arm out. Let's just say I felt the pain.

"I waited about 30 minutes to be seen. It's a good service."

Mabel Baker, 83, from Shriven-ham, was also in casualty that morning after suffering an asthma attack.

She was in the capable hands of 29-year-old clinical fellow Dr Richard Hodgson, who put Mrs Baker on a nebuliser and arranged for her to have chest X-rays.

Mrs Baker, a former nursing auxiliary herself, said: "I'm very comfortable now. I couldn't have been looked after any better."

Diabetes sufferer Richard Blackford, 45, of Haydon Wick, had been referred to the AAU by his GP after his leg became inflamed.

He said: "I had a bike accident and noticed that my leg had become inflamed and swollen.

"The diabetes means my circulation isn't great.

"I was referred here and have been put on antibiotics for a week. It's a good idea to have this unit as it saves all the waiting around."

Alex Emery