The study on streaming quoted in REC will be published shortly in EMJ. It
simply put one doctor in a cubicle, with a desk but no couch, and he only
saw the walking wounded.
This system reduced the risk of waiting over one hour by 30% ( and did not
worsen waits for other patients). There were no extra staff used to create
the system. I believe it worked just because it stopped the system clogging
up with too many people and the familiar situation of no cubicles being
available. A recent survey showed that about one third of A&E departments
already operate minor injury "fast track" systems.
Matthew Cooke
Univ Warwick
----- Original Message -----
From: "Goat" <[log in to unmask]>
To: <[log in to unmask]>
Sent: 28 October 2001 11:31
Subject: Re: Reforming emergency care
In article <00fc01c15d8a$770a0560$3e1699c2@wghlaptop>, Dr Matthew Cooke
<[log in to unmask]> writes
>I would be very pleased to get peoples comments on the document either via
>the list or direct to me. These will then be fed in to the implementation
>process.
Re. streaming.
Accepting the evidence that this improves average time in dept by 30
mins, surely this is because of the extra staff and space resources
which must inevitably follow the streaming process envisaged in the
plan. The financial figures trumpeted in the plan seem impressive to a
this staff grade, but we might expect an extra 1 whole time nurse out of
the 600 promised in the plan. Even with highly inventive and creative
alterations to our streaming, how is this 1 extra member of staff going
to deliver the planned improvements?
My impression is that we already do streaming: its called national
triage. What stops us physically separating streams according to
clinical need is lack of space and staff. Our single pool of staff work
flexibly with the "triage-streamed" patients according to need. This is
NOT the same as "treat all the triage 3 before the triage 4 patients".
Our computer system automatically orders all patients according to
triage score and time waiting. To duplicate 2 (or more) separate pools
of staff for streams must inevitably REDUCE efficiency unless
considerable investment in space and staff occurs.
Dr G Ray
A&E
Sussex
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