Though the measure is number of admisions, we are certainly aiming to
discharge safely, and direct people to an appropriate place of care. I would
hope that with more experience we would be more likely to pick up conditions
like SAH and investigate them appropriately than inexperienced SHO's
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Goat
Sent: 09 March 2002 16:23
To: [log in to unmask]
Subject: Re: bed pressures and admission avoidance
In article <004c01c1c759$8fb1de60$2815e150@mason>, Suzanne Mason
<[log in to unmask]> writes
>The main outcome is mean
>number of medical admissions perday.
Word of caution here. Danny has already highlighted how important it is
to watch early re-admission rates. I'm sure a lot of people we see could
safely go home. The trick is not to send home the ones that need to come
in. An example of established good practice is the chest pain (ROMI)
protocols which most people accept as safe and "bed-efficient". However,
I remember a couple of patients with "non-specific headache" discharged
by a medic without investigation who were back in 24 hours wiped out
with a SAH. Their initial admissions were certainly prevented, perhaps
at some personal cost to themselves. More power to your elbow if you can
come up with acceptable risk guidance on such patients.
We are asking the wrong question. Not "how can we prevent admission?",
but "how can we discharge safely?". Small difference, but important.
Barely a week goes by without me stopping non-medically trained bed
managers from pressurizing junior docs into discharging patients who
should be admitted. The bereaved relatives come looking for the doc the
next day, not the bed manager.
Dr G Ray
A&E
Sussex
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