In message <[log in to unmask]>, [log in to unmask]
writes
>I was involved in a study in Trafford hospital in 1999 which may be of interest.
>
>
>Whenever the A&E staff grade there saw medical patients he clerked them in,
>organised initial investigations and treatment and admitted them directly to
>the medical ward with a management plan. Whenever the rest of the A&E team saw
>medical patients they referred them to the on-call team as in most hospitals.
This is more or less what we do, informally. I usually let the on-call
medics / othopods / surgeons know about the patient only AFTER they are
on their way to the ward. This stops the ridiculous situation of
yesterday's medical student taking an hour or 2 to attend A&E, repeat my
assessment, ask the patient if they keep parrots or if they have any
marital probelms that are worrying them at the moment, order a whole
load of totally unecessary XRays, USS, blood tests, then INSIST the
patient waits in A&E (with their acute appendix / #'d NOF / CVA) until
their registrar sees them. The on-call registrar is invariably in clinic
/ theatre for the next 6 hours.
I don't ward any patients if there is some doubt about which ward they
would be best managed on. We DO make sure all ESSENTIAL investigations
and management are underway before warding. Never had any complaints
from my specialist colleagues.
There are occasionally complaints when A&E SHOs or nursing staff try and
make these decisions about "accepted" patients. This causes a lot of
bad feeling when it goes wrong, since it is much easier to get essential
investigations / treatemnt done in A&E where all the best nurses and
equipment are. Sad endictment of the state of general wards these days.
Dr G Ray
Staff Grade
A&E
Sussex
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