What is needed is a name that allows flexibility. Eg; Staff working in a
'minors' area will get agitated if a patient with renal colic is sent there
but if another area is full it may be the best place for that patient to be
seen.
Secondly if you give a particular area a categorisation then you allow for
the 'Emperors Clothes' phenomenon to exist. We all know how much harder it
is to lose a diagnosis than to gain one. Thus a patient who falls off a
ladder and sustains a chest wall injury who walks in to the department may
be seen in the 'minors' area and will be told the diagnosis is 'minor'
bruising to the chest. His brother with exactly the same injury seen in
another area will have an ultrasound of the abdomen and may even be
reviewed by a trauma team. Calling a zone a 'minor' area can unfortunately
underplay the seriousness of some patient's problems. Surely a patient's
problem is a only minor one when it has had a thorough evaluation. And we
need to respect public perception. A self employed labourer with a young
family who sustains a grade 2 ankle ligament sprain does not have a 'minor'
problem.
So why not use a generic name that allows flexibility in terms of where you
see different types of patients as demands on resources change ? We have
agreed protocols for which types of presenting complaints should be seen in
which zones but when we need to be more flexible there is less
territorialism by staff working in the carious zones.
We have called our resuscitation area 'Zone 1', our higher dependancy area
'Zone 2', our 'ambulatory care' (I like this one to) area 'Zone 3', Our
paediatric area 'Zone 4' and our short stay ward/clinical decision unit'
'Zone 5'.
We have the same problems with exorcising the word 'minors' in much the
same way as we have with the word 'casualty' but we are getting there.
John Ryan
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