In message <[log in to unmask]>, "P.
Ransom" <[log in to unmask]> writes
>the safety valve is to go on
>ambulance divert. Lots of browbeating from management, occasional eyebrows
>raised from other hospitals who take up the slack
The problem here is that the usual state of affairs is for ALL
neighbouring departments to be in an equally bad state. Things have got
so bad that ther is no "slack" that can be taken up elsewhere. It's not
the feeling of failure that stops us closing, its the knowledge that by
diverting, we are likely just shovelling the problem down stream.
>Does anyone practise this in the UK ? And what criteria would you have for
>going on bypass ?
This should always be considered last resort.
Departments are designed and staffed for a certain maximum number. There
should usually be plenty of "spare capapcity" to allow us to cope safely
with the occaional unpredicatable bad days. Whenever there is no spare
capacity (i.e. there is no appropriate space for the next patient),
drastic action is called for: diversion, cancel planned surgery, beds in
recovery, beds on day ward etc.
Trolleys in corridors are NOT appropriate places to care for patients. I
know it ahppens, that doesn't make it right. We are the ones at fault
for letting it happen.
I still try, usually in vain, to warn managers of impending crisis. Only
the best managers realise the value of PREVENTING crisis rather than
REACTING to it when it happens.
A prediction:
as A&E has been deemed the flood plain of acute care, where all the
overflow goes when bed demand exceeds supply, it is only a matter of
time before a patient suffers seriously as a result. I don't believe
this is hyperbole. I pity the poor sod who's at the coal-face at the
time. Apart from the natural feeling of guilt and responsibility for
their patient, the poor sod will find managers / politicians blaming the
whole lot on "clinical inadequacies". I hope its not me.
Dr G Ray
Staff Grade
A&E
Sussex
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