After being seen at A&E: discharge, follow-up and what to watch for

A&E discharge is a clinical decision that you no longer need emergency hospital care. It is not a confirmation that everything is fine, that no follow-up is needed, or that you can return immediately to your normal activities. Treat the discharge conversation as the most important part of the visit.

Before leaving the cubicle, you should know the answer to all of these:

• What was wrong — the working diagnosis or list of possibilities.
• What was ruled out — the serious things they checked for and excluded.
• What treatment was given — drugs, fluids, dressings, procedures.
• What medication you have been prescribed — names, doses, frequency, duration, possible side-effects.
• What follow-up is arranged — clinic, GP, scan, blood test.
• What ‘safety-netting’ symptoms should bring you back — clear, specific red flags.
• How long you need to rest and any restrictions (driving, work, sport, alcohol).
• Where to find your discharge summary — paper, email or hospital app.

A&E will normally give you the first few days of medication free from the hospital’s ‘TTO’ (To Take Out) pharmacy before you leave. Anything beyond that goes on a community prescription that you collect from your usual chemist.

• Take the first dose before you leave if instructed — many antibiotics and pain medications work best with a loading dose.
• Standard NHS prescription charges apply (£9.90 in England, free in Scotland, Wales and Northern Ireland) if you don’t qualify for free prescriptions.
• Always finish the antibiotic course unless told otherwise — even if you feel better.
• Mention all current medications to the prescriber (including contraception and herbal supplements) — interactions are the most common reversible cause of a return visit.

Follow-up after A&E falls into three buckets:

• Same-hospital specialty clinic — fracture clinic, ENT, ophthalmology, surgical assessment. The hospital will phone or text you within a few working days; if nothing arrives within a week, ring the relevant department directly.
• Your GP — for review, repeat prescriptions, ongoing symptoms, sick notes and onward referral. Book this yourself; the discharge letter goes to them, not from them.
• Community service — district nurse for dressing changes, physio, mental-health team, community midwife.

For employed UK adults:

• First 7 days — you can self-certify (your employer gives you the SC2 form, or you write a brief letter). No clinician note needed.
• Day 8 and beyond — you need a Statement of Fitness for Work (‘fit note’). A&E doctors can issue these for up to 7 days from discharge; longer than that needs your GP.
• Fit notes can say ‘not fit’ or ‘may be fit with adjustments’ (modified hours, lighter duties).

The single most important thing the discharging clinician should do is give you a personalised list of safety-net symptoms — specific red flags that should bring you back. Generic ones that apply to almost everyone:

• Symptoms get rapidly worse rather than steadily better.
• New symptoms appear that weren’t there before.
• Persistent vomiting that prevents you keeping medication down.
• High fever (over 39 °C in adults, anything in babies under 3 months).
• Sudden severe pain that wasn’t there before.
• Confusion, drowsiness, slurred speech, weakness on one side.
• Severe breathing difficulty.
• Wound becomes hot, red, swollen, leaking pus, or you develop a fever.

Coming back is always OK. A re-attendance does not mean you’re a time-waster — A&E expects them and triages re-attenders quickly because they’ve already been ‘lost to follow-up’ once.

If something about your care doesn’t feel right — explanation unclear, you felt dismissed, the discharge happened too fast — your first stop is the hospital’s Patient Advice and Liaison Service (PALS). Every NHS trust has one; staff at the front desk can point you to it.

• PALS resolves around 70 % of concerns informally without going to formal complaint.
• Formal NHS complaints are handled under the NHS Complaints Procedure and you have 12 months to raise one.
• If unresolved, you can escalate to the Parliamentary & Health Service Ombudsman.

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