> This system of parallel streams seems a waste of resources.
> Surely what is
> needed is a properly funded afterhours primary care system
> and adequately
> resourced emergency departments. Triage works - most australian and NZ
> emergency departments keep within their triage times, the problem is
> resources not the actual system itself.
>
> Why not spend the money funding the current system properly ?
The money being provided is going largely to specific things like increasing
nurses. However, DoH feels that a lot can be done to improve efficiency.
Oddly, I tend to agree. They've set a whole lot of targets that trusts will
have to achieve. This should help us. For instance, the 90% of patients out
of the department within 4 hours by March 2003 means that we won't be able
to keep patients in awaiting assessment by other specialities; and won't be
able to tie up our own doctors doing a lot of 'routine' investigations-
these will be done in a clinical decisions unit. This should free up staff
to 'fast track' the minors which shouldn't take long. I've wanted to do a
lot that's in the document; but have been stopped by the trust having other
targets (mainly waiting lists) to meet whereas my department was achieving
pretty well already. This document may change that.
>
> As I read this there will be up to 5 parallel systems on one
> site, and if
> one stream is overloaded then the others wont help - because
> their priority
> is to their own stream. So if your resus stream is
> overloaded, you wont be
> able to take your minors staff to see the more serious cases
> ? So sprained
> ankle ahead of chest pain. I dont understand the logic of
> this.
Yes, that's what it says. The only way it's likely to be workable is NPs
dealing with the minor injuries; primary care and self care streams (except
in the few departments with enough doctors to dedicate one to those
streams). Of course, another interpretation is that you can no longer take a
doctor out of 'majors' to clear the waiting times.
> Who is going to be overseeing all the streams ? What is the
> role of the ED
> consultant ?
As far as I can see from the document; initial assessment and resuscitation
of the seriously ill patients; advice on the others.
> Surely the whole point of a triage system is so that
> resources are delivered
> appropriately in an appropriate time frame.
No, triage is sorting patients to appropriate care- something that has
largely not been done before. This system will hopefully result in patients
with emergencies being treated quickly and those without being redirected
(always thought it was a bit of a problem calling something an emergency,
but accepting a 4 hour wait to be seen). For years, many departments have
treated minor medical problems badly and expensively (funding and staffing
being based partly on crude attendance numbers). The only way we can achieve
the targets is by directing those patients better treated elsewhere away.
>
> What emergency care in the UK needs is a MAJOR cash injection - more
> consultants, more middle grades, more SHO's, more nurses. IMO all the
> current system needs is this (with some other less radical
> fine tuning) -
> its fine to change the system but without the cash this will
> just rearrange
> the deck chairs
The trouble is that the major cash injection has happened. As the DoH points
out, over the last 10 years, A and E staffing has been growing faster than
attendances but waiting times have been increasing. Unless we (those in the
speciality; BAEM; FAEM etc) can provide an alternative explanation, this
will be attributed to inefficiency. We are at an awkward stage where to a
politician or manager it looks like we've had a fair chunk of the big
consultant expansion we've asked for; but haven't shown any improvement in
service as a result (and increased consultant presence is not taken as an
improvement- that's just saying 'The improvement as a result of the extra
resources is that we've got more resources')
Maybe I'm overly optimistic about some of the aspects of the report; but I
think in general it could benefit us- sets us real targets which will help
us to argue for the changes needed to achieve them.
Matt Dunn
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