Rowley's not kidding! Thsi is a common misconception from people who don't
understand the basis of emergency medicine. 70 patients a day could easily
be seen at a fracture clinic but this is only after they have been filtered
for the NOF following an MI or stokes adams attack, the person who has a
fracture and a burn, a broken clavicle along with acute alcohol withdrawal.
When will these folk get it that it is dead easy to believe everything is
straightforward once the initial sorting of undiffirentiated has been done
proprely. Patients do not come in neat little diagnostic groups. The idea
that 4 orthopaedic SHOs could work through an average of 70 patients a day
who also have fractures as they come in through the door is not realistic.
A nice example is the last time we hired an experienced orthopaedic doctor
to do a locum A&E SHO shift. We initially thought he was great as he was
extremely fast. A few days later we discovered he had missed 4 or 5
fractures in a single shift! This was simply because he was seeing a
diffirent population of patients where the fractures had not already been
diagnosed.
As nobody once said "shut up and see some patients!"
Phil Munro
A&E Glasgow
Grrr!
> "Where is the logic in asking patients with fractures to wait for 1-3hrs
in A&E and then either
> a) wait another 1-2 hrs for the Ortho SHO to see the patient only to
repaeat what had been said or done in A&E
> b) patients have to come back to the fracture clinic the next day to
repaeat the same performance.
>
> I know the argument is to ensure that no mistakes are made, but then how
will the A&E SHO get the feedback. Where is the
> education value in our current arrangement.
>
> 60-70% is an overestimation (unless you include every little scratch and
bump), not supported by literature. Realistically, you are
> talking about 40,000 p.a. in Leicester. About 15,000 will come to the
Orthopaedic department anyway so you are dealing with an
> extra 25,000p.a. That's <70 per day. 4 SHO's should do it.
>
> I know it sounds drastic but I think a radical change is necessary.
Perhaps the bottom line is that A&E has to work much closer
> with the Orthopaedic department. The idea of an Emergency Alliance is very
much on the scene in my local hospital but I think we
> have to go much further than talking."
>
> This would seem to be an orthopeadic surgeon, with the name of Tony Hui.
>
>
>
> Best wishes,
>
>
> Rowley Cottingham
>
> [log in to unmask]
> http://www.emergencyunit.com
>
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