Also, I think a presence in the department is especially important for
thrombolyis. OK, you'd expect even an SHO to diagnose a barn-door MI, but
we're seeing cases earlier and earlier now. The public are increasingly
calling 999 for chest pain, and getting to our department in around six
minutes. So I'm seeing early evolving MIs less than an hour from pain. These
ECGs (and patients) aren't always easy, and are tough for a first year SHO,
which is all I've got. With senior presence we're now achieving 100% lysis
within 30 minutes, with medians below 20 minutes, for our last quarter. This
figure could not be achieved over the telephone or by racing to the
department (although I'd secretly love it if my job allowed me to race my
car through the city at night!).
Adrian Fogarty
----- Original Message -----
From: "Fred Cartwright" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, July 31, 2002 11:09 AM
Subject: Re: 24 Hour 'Senior' Cover
> The problem I see with this is it is not always the
> sick patients they screw up on. It also implies that
> less ill patients don't justify consultant care. Of
> the balls ups that I've seen over the years few have
> involved really sick patients - to start with! A
> recent example was a 20 something cyclist who came off
> his bike and landed on some gravel, lacerating his
> left elbow. Seen by quite an experienced SHO on the
> surgical rotation who cleaned and dressed the wound.
> When I saw him 2 days later and X-rayed him he had
> subcutaneous gravel halfway up his forearm and early
> gas gangrene! That cost the trust a few grand! Most of
> the big payouts have been for similar things, missed
> diagnosis or suboptimally treated conditions that have
> deteriorated and caused the patient harm.
>
> Cheers Fred.
>
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