----- Original Message -----
From: "Rowley Cottingham"
Subject: Re: audit commission report
> There are three reasons for extended waiting times in Emergency Units.
These are inadequate numbers of staff to see
> patients (doctors or Emergency Nurse Practitioners), insufficient support
staff (mostly nurses and receptionists) or
> insufficient space. The audit commission drew only two conclusions; the
total number of patients attending has
> increased modestly in five years, and the number of staff has increased.
They seem perplexed at the increased waits.
> One plausible explanation is a changed case mix. More people attending
hospital are admitted, arguably an excellent
> proxy for a greater proportion being more ill. In my own Unit, the
proportion being admitted between 1995 and 2001
> has increased by up to 60.3%. These patients rarely spend less than 2
hours each in the department, often much
> more, and as they are often acutely ill, tie up nursing and space
resources.
A very good point Rowley, well observed.
> Rarely does excessive waiting result from a dearth of doctors, but a
dearth of nurses and space. If people cannot get
> into a hospital bed they have to wait somewhere, and using our Emergency
Units as this storage facility impinges
> severely on the care we can give the next patient.
I'm a bit worried about this one though. The Audit Commission report very
clearly defined two indicators of waiting, the time to see a doctor (or
ENP), and the time to admission, transfer or discharge. As far as the former
goes, clearly excess waiting does indeed result from a dearth of doctors (or
ENPs). In every department I've worked in (around a dozen) the rate limiting
factor has always been the doctors (but I'm not talking about waits for
admission here).
Adrian Fogarty
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