Rowley - at the FAEM conference in Plymouth, Sir George Alberti agreed that
the 4 hr turnaround is impractical and dangerous in some cases (e.g.
asthmatics waiting review after nebs, awaiting CDU investigations that may
avoid admission etc). He intimated that this 'target' is going to be
revisited and stratified so that it is only pertinent to conditions that you
would expect not to be in the department for longer than 4 hours.
Incidentally, he seemed to talk a lot of sense and also LISTENED to views
and opinions. I must admit to being sceptical about a non-A&E doc taking on
this role but I was pleasantly surprised by his enthusiasm and knowledge and
feel more comfortable about his involvement. Another comment made that he
made note of was the complaint that we are being constantly bombarded with
new strategies and that we are only just getting to grips with streaming
when "see and treat" is coming in.
Incidentally, in our unit, we do not need to talk to medical SHOs to admit
medical patients. We have an agreement that if any A&E doc thinks a patient
should be admitted medically, the nursing staff pass the details on to the
MAU and the patient gets admitted. If the A&E doc is unsure or feels that a
more immediate opinion is needed, the medical middle grade then sees the
patient in A&E. Surprisingly, this works very well. There are very few
inappropriate referrals and the few that do slip through are accepted by the
medics as inevitable with such a system. Most importantly, there are no
battles with junior medics over admissions and no copious amounts of
needless investigations to justify a referral.
Naturally, our version of Utopia still has a hospital with too few beds!
Andy
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Rowley Cottingham
Sent: 27 November 2002 23:12
To: [log in to unmask]
Subject: Re: See and Treat
Thank you John; you bring me on to another issue with which I disagree -
the UK Government have decided to set targets for patient transit
through Emergency Departments. Next April 90% of patients are to be out,
April 2004 100%. I have great clinical unease about this - there are
seriously ill unstable patients who may take more than 4 hours to sort
before they are safe to move. I know of no clinical evidence that there
is benefit to this, and I meant to take this up with the advisers. I
know Mike Lambert reads this list, and I think my friend Matthew Cooke
looks in occasionally too. Matthew - can you bring my clinical concerns
to the DH and try and get it stopped at the 90% 4 hours level and say
100% at 8 hours?
After all, you can wait 4 hours in an airport lounge between flights and
no Government is jumping up and down about it!
R.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of John Chambers
Sent: 27 November 2002 22:54
To: [log in to unmask]
Subject: Re: See and Treat
The problem is that in patient beds are always under pressure and
medical and surgical registrars have this optimistic hope that by the
time they see a referred ED patient the symptoms and signs will have
vanished and the patient can be discharged - and this does happen in a
few patients each day, time is a great healer! You must have some
sympathy of registrars from the in patient specialties . They are given
a hard time if they "fill" the wards with "soft admissions" both from
their own bosses and their hard nosed peers. They do not really care or
lose sleep worrying what the ED middle grade staff think about them.
Conversely if the ED staff could admit and seemed to be filling the
wards with "soft admissions" Rowley's prediction is quite right - the in
patient specialists would simply refuse to take responsibility for these
patients. Our ED works as the "hub" of the hospital where all the
referral and admitting takes place. Patients only go to the ward with
all drugs charted and treatment plan complete. Works pretty well but you
do need staff and space. We work as a team alongside specialty
registrars and try and avoid duplicating the same steps of the admitting
process. Simple quick direct ward admissions by ED middle grade and
senior staff are a bit of a dream rather than an achievable reality -
would come back and bite you big time. JohnC PS in many Australasian
Hospitals there is rather too much repeat clerking. The grass is not
always greener!!
-----Original Message-----
From: Brendan Conway [mailto:[log in to unmask]]
Sent: Thursday, 28 November 2002 11:31 a.m.
To: [log in to unmask]
Subject: Re: See and Treat
I'm re-sending this as it didn't appear on the list...
The single best way to reduce inpatient waits is for A&E middle grades
and consultants to have the authority to admit patients directly to
wards. This would have a dramatic impact on patient comfort, reducing
trolley occupancy, and preventing work being repeated. The current
system of clerking after clerking is a mess!
Opinions, please!
B Conway
SpR Medway
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