1.3 Why is the process for treating a patient with appendicitis so difficult? When an acutely ill patient needs to be treated urgently, the whole healthcare system has to respond in a co-ordinated manner. For example, if a patient attends a general practitioner’s (GP)

clinic with abdominal pain and the GP assesses this as a probable acute appendicitis, the patient needs to be admitted to hospital for surgery immediately. First the GP might phone a house officer at the local general hospital to agree the probable diagnosis, so that the patient can be

‘surgically accepted’ by the hospital. An ambulance will be immediately requested, to take the patient to hospital. However, the target response times may be breached if the ambulances in the area are allocated to other emergencies.

When an ambulance arrives to take the patient to hospital, the GP usually gives the paramedic a letter of admission to take with the patient. This contains any immediate patient information that the hospital staff may find useful, including drugs that have recently been prescribed for pain relief.

Ideally, ambulance paramedics should be given the same information so that they know what treatment has already been given, to avoid duplication.

This does not always happen, especially if the doctor is unable to meet the ambulance crew themselves.