A&E self-discharge after chest pain and flight, would tests still count?

[vitahelp]

My relative went to A&E yesterday with chest pain and shortness of breath following 12 hour flight a week ago. They had called 111 prior and been advised to go, they even wanted to send an ambulance which was declined and relative drove there.

Rough timeline (all from within main waiting room)
19:30 arrived
19:45 triaged, sent for immediate blood test, ECG, chest xray
20:30 all above were complete
21:00 doctor sees them. They think he said there the results so far were ok but not 100% sure. He said they would need another blood test which we think was the d-dimer test.
00:00 nurse takes blood pressure and says doctor will see them soon about blood test results
02:30 they self-discharged

I’m not looking for comments on the self discharge as what’s done is done. But can anyone help with the following:

• If they did suspect a blood clot on the lung would things have moved quicker in A&E, so can we reasonably assume that wasn’t the case.
• If the blood tests have come in and highlighted an issue would they call to inform or would it just be left because of the self discharge.
• If they were to return to A&E today would all tests need to be done again? We already understand they would be at the back of the queue, but wondered if they would be treated as a brand new case as though yesterday never happened?

Hi, I’m an A&E sister…
sorry to hear your relative wasn’t feeling well and also sorry you have had to experience the A&E system which is horrendous (us staff despair at it too).
to answer your questions….
if they were sure there was a blood clot they will have treated as if there was one until proven otherwise by means of blood thinning injection until a CTPA could rule it out. You would not have been moved through the A&E system any quicker necessarily as too many variables…..volume of patients, acuity of others, resus emergencies and traumas etc. I would be assuming they had referred them onto general medicine and would have been awaiting admission to a ward which in my trust can take well over 24hrs for a bed.

If you have left and results come through which are important for further treatment…I would expect the patient to be recalled to return. The GP would also be informed. You would then rebook back into ED but the triage nurse would escalate to the relevant person ie ED consultant in charge or to the medical team if the patient was originally referred to them before they left.
the tests would not require to be redone as they are recent but there would probably be a request for a repeat ecg. I will note that a positive d-dimer can result from various causes….its a useful tool to guide diagnosis but not to be taken as gospel on its own.
you can chase the results from the gp as they will be sent to the gp too on their system.

The self discharge aspect….i absolutely understand why they did this, the waits are horrendous and they were there a long time, I would imagine the dr didn’t return due to acuity of their other patients rather than ignoring your relative. obviously any concerns please seek further medical opinion x

Are they still having symptoms? I think the second ddimer is to double check for potential heart attacks if first was not conclusive. It may have been clear or prompt further tests. Were they given a discharge summary or is it on the nhs app? They would need reassessment by next day.

A D-Dimer is for active blood clotting conditions, not for heart attacks. The blood test for suspected infarction is the Troponin.

Assume nothing.
If they're still having symptoms they probably need to get seen and wait - there's plenty of other things that can cause chest pain and shortness of breath.

Thank you all for your helpful replies. In the end relative returned to A&E late morning and was given an appointment at a hospital UTC department where the blood tests were repeated and thankfully there is no indication of clotting. They have been discharged now and have reassurances that it is not anything sinister and it has been assumed the chest pain and tightness are a secondary symptom of a previous back injury which was aggravated by the long flight.

It turned out the blood test result they were waiting hours for last night had not been done in error so they would have been waiting for nothing if they and stayed!