I haven't excluded the SpR in the slightest, but the fact is that a
great deal of the knowledge needed to deal adequately with this sort of
injury is gained in the first 6 months - as you rightly say, the final
15% to deal with these injuries with excellence takes another 5 years.
What concerns me is the the history we know of obstetrics; few O&G SpRs
get huge experience in delivery and tend to bale out with Caesarian
section rather than use devices such as Keilland's midcavity rotation
forceps. If that happens, patient care can but suffer.
R.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Simon McCormick
Sent: 24 November 2002 16:24
To: [log in to unmask]
Subject: Re: See and Treat
Rowley,
Its not just the experience and training of SHOs you should be worried
about, what about new SpRs. With the trend to completely separate minor
injuries from the rest of the department and have them seen by ENPs,
there is less opportunity for middle grade exposure to these problems.
Also, and probably quite rightly, with increasing input to trolley
patients and resus cases by middle grades their time is eaten up with
this type of care. What will be the knowledge of minor injures etc be
of new consultants in A&E in 10 years time? Some might say that they do
not need this experience and Nurse consultants will take this role over
completely by then, I'm not so sure. Now, when ENPs get a case that is
tricky, unusual or outside protocols they tend to look for an
experienced doctor for help. Also, what of the multiple injury patient
who has a fractured femoral shaft, minor head injury, dislocated little
finger and a laceration of his upper arm. Will the ED Doc manage the
fracture and call the ENP to deal with the 'minor injuries'?
Just some thoughts from one of the last with 'old style training'!
Simon McCormick
P.S. Do you think the public/courts are ready to call on Nurse
Consultants as expert witnesses in cases involving minor injury
standards of care??
----- Original Message -----
From: Rowley Cottingham <[log in to unmask]>
To: <[log in to unmask]>
Sent: 23 November 2002 18:52
Subject: Re: See and Treat
> See and treat can help immensely in minors; however, the gain is
> almost entirely from one simple change; empowering the assessment
> nurse to treat there and then and discharge or simply to turn the
> patient away untreated (i.e. the self-help stream). That is not a
> trivial change to implement and essentially needs an ENP. The only
> thing required after that is a defined escalation policy and
> escalation levels. However, several of us are uneasy about the change
> in the case mix, experience and training of SHOs which nobody seems to
> have thought about.
>
> R
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of
> [log in to unmask]
> Sent: 23 November 2002 18:12
> To: [log in to unmask]
> Subject: Re: See and Treat
>
>
> I attended the Leeds "See and Treat" bunfest.
> The co-ordinator or whatever she was patronised us to hell and beyond.
> I have experience of her style from her former life in A&E! The
> general feel from the clinicians on the floor was that with adequate
> staff levels, exercises such as see and treat would not be required.
> The demand to do this as well as take on ECL,Streaming, Education,
> Audit and see patients and manage a department is excessive. The
> presentations I saw were for the use of ENP's managing the minor
> stream with a nominated middle or senior clinician, and another for a
> dedicated minor side. We had a dedicated minor side in Sheffield at
> the Hallamshire and Hull for years but still would get overloaded when
> the numbers rose. I have three MIU's run by ENP's who also get
> overloaded. We have never Triaged in Scarborough because we have never
> had enough staff. Now they tell us Triage is passee! I never thought
> of it as I have seen it performed, as anything other than a crowd
> management tool. I am trying to install "Empowered Triage" which is
> realy low level ENP function on protocol. The only real way to cope
> with the patient numbers is to have Expensive Trained clinicians, ENP
> or Medical of sufficient numbers and seniority so that we can assess
> and treat. Where is the miracle cure in that? APV
>
> >Colleagues
> >I see from the attendees list that there was a large turn out for
> yesterday's study day in Manchester on the above topic. Unfortunately
> I couldn't attend. Through the list I would like to canvas people's
> opinions. Without wishing to offend some of the quasi acaedemics who
> seem to flourish on this list I will keep my own council but I would
> value other comments.
> >
> >Danny McGeehan
> >
> >
> >
>
|