Nick Sentance wrote:
> Our local hospital has started a system which allows the ambulance crews to
> request direct admission to CCU for obvious or suspected cardiac conditions.
> Basically the admission criteria is any patient where the crew have, or
> would have, administered Aspirin.
> The door to needle times have come down dramatically.
> Unfortunately I have not got the figures to hand, but if memory serves
> correct, D to N time through A&E was about 60 mins and through direct
> admission, 15 mins. The unit reports that the ambulance crews have been very
> good at recognising cardiac conditions and only a handful of patients have
> been referred to another ward.
This seems to perpetuate the notion that if a patient has an acute
cardiac
emergency they should not be in an Emergency Department.
If an A&E service cannot provide immediate assessment and if indicated,
rapid
access to thrombolysis (and defibrillation if required) the solution
must surely
be to raise the standards of care in that emergency department not to
bypass
that department.
Other studies have shown that thrombolysis is more rapidly administered
to
patients brought to A&E than those transferred from A&E to CCU AND THAN
THOSE
ADMITTED DIRECTLY TO CCU. The additional benefits of A&E admission
include the
fact that the patient might actually have a different medical condition.
When I
think of the high proportion of patients who have been given asprin or
poisoned
with nubain for non-cardiac chest pain that I see in A&E I am very glad
that
direct CCU admission is not the norm in my area.
A "leak" in this weeks Hospital Doctor magazine suggest that the report
of the
A&E modernisation team may recommend more bypassing of A&E for some
clinical
presentations. I hope that this is not the case as I hope to be starting
my
consultant career in a specialty which is increasing its expertise in
providing
emergency care not narrowing its focus to revert to a "Casualty"
service.
--
Andrew
_______________________________________________________
Andrew Hobart FRCS FFAEM
Birmingham
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