>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
>Reply to [log in to unmask]
>
>
I think this is one of the problems with a system of direct admission to the
wards especially when it is performed by junior A&E doctors. Sometimes patients
won't have had the appropriate tests or treatment in A&E and thay may not be
seen for hours on the ward to have this rectified. A recent study in the region
has suggested that patients with #NOFs who are fasttracked do worse than patients
with #NOFs who spend longer in A&E.
I think this problem can be solved by:
-Employing senior doctors in A&E!!??!!
-Using evidence/consenus based guidelines to "process" patients in Clinical
Decision Unit settings before transfer to the ward.
-Keeping patients who need it for up to 6 hours in CDU until they have been
investigated and stabilised. (This will still be faster than yesterday's medical
students and their registrars!!)
-Contacting the on-call team about patients being admitted and dividing them
into 3 groups:
.stable patients who can be reviewed later on the ward e.g elderly CVAs(provided
all tests done, on IV fluids if no gag etc etc)
.unstable patients who should be seen sooner probably while being stabilised
in A&E e.g. severe improving asthma
.CCU/ICU patients who will be admitted under the care of the ICU/CCU team
as usual.
Ross
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