I do think that we are, as so beautifully described, arranging deckchairs on the Titanic. The triage
process itself is an admission that we have too few doctors/ENPs to see patients at the rate they
turn up - under normal circumstances. It relies on the sporadic nature of attendance to allow the
doctor to catch up; three people come in within 10 minutes and each takes 20 minutes to be seen.
This works fine if nobody then comes in for an hour. (It has now taken on a bizarre life of its own. If
the department by some chance happens to be empty, the poor patient STILL has to be seen by a
triage nurse before they get to see the doctor! Why?)
I digress. It all goes wrong if the level of attendance overwhelms this substitution of time for staff.
Patient numbers slowly accumulate in the waiting room until such time as the inflow abates;
normally between 23:00 and 02:00, depending on the type of department. There is then a large
cohort of increasingly angry and usually sobering, usually young people who then cause problems.
Now we are planning to use another doctor to see the patient before the nurse before the doctor.
And that saves time, huh? Come on guys, the King's new clothes are not purple. There has been a
moratorium on SHO numbers since 1998. Staff grade posts are now being filled by people waiting for
their SpR number, few people want Trust grade posts and every department I know needs more
medical staff - full stop.
It is so important that we do not allow ourselves to be diverted from the real issues by this sort of
rhapsodising.
Best wishes,
Rowley Cottingham
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http://www.emergencyunit.com
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