I think the other thing that we have to take into account is the amount that
we actually do for our patients these days.
It takes much longer and occupies many more resources to thrombolyse a
patient in the ED rather than "slow-tracking" them to CCU. Likewise we spend
much more time investigating, treating and observing than we used to. Simply
counting the number of staff and the waiting time doesn't allow for changing
acuity, increasing intervention or better standards of patient care.
Jonathan Benger.
SpR, Bath.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Dunn Matthew Dr. (RJC)
ACCIDENT & EMERGENCY - SwarkHosp-TR
Sent: 26 March 2002 09:43
To: [log in to unmask]
Subject: Re: Initial medical assessment
>
> Waiting times have increased because the method of working
> has been forced to change by
> reduced bed availability. A&E nurses are being utilised to
> look after patients who should be on
> wards. This reduces the number that can be made available to
> the minors 'stream' so slowing down
> that stream as well. The acuity of care required is the
> variable that has changed most rapidly and
> has caused the slowdown - for reasons beyond A&E's control.
>
Yes, I think you're right, but I'd like to see the proof (and I'd like even
better for the DoH to see the proof). Certainly, my perception of A and E
departments has been that the waiting time corresponds more closely to how
long patients referred to inpatient specialities spend in the department
than to attendance rate: staffing ratios. There's a number of papers around
showing that staffing is a poor predictor of waiting times. I haven't seen
anything looking at referral to admission times against waits to be seen.
Would be useful, needs a bit of work on how best to do it. Possibly compare
departments that have other specialities regularly clerking in patients in A
and E with those that don't?
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