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From: Accident and Emergency Academic List
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Sent: 24 November 2002 19:56
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Subject: See and Treat
There are a number of things that are not so clear to me about "see and
treat":
1. Who decides (and how) whether a patient should be seen in minors or
majors?
Ambulances tend to start at majors and people walk in to minors. Simple
as that!
2. If the staff is still the same and the attendances are not reduced,
why should "see and treat" reduce significantly the waiting time?
Good question. It is because you are preventing a significant proportion
of patients sitting in the waiting room for hours from doing so. I have
to say I support this - I would be greatly upset to be kept waiting for
3 hours to be told to go away too. The problem has been about empowering
the assessment nurse to say this. The rest of the stuff about SHOs in
rooms waiting gratefully to deal with whatever the nurse deigns to send
them is really nonsense.
3. How will you be able to have the full picture of the state of the
Department at any one time, if you do not know what is wrong with the
patients who are still waiting to be seen and treated, and will not be
triaged?
I do not see why the 15 minute rule to see the assessment nurse needs to
be breached. Thus, except in exceptional circumstances you know within a
patient or two what is going on.
4. If you need a senior doctor to see and treat patients, who will see
the critically ill patients, (particularly out of hours - i.e. nights).
Yes, this is an important issue. The answer is that you do not use your
most senior doctor on the front line except in exceptional circumstances
- it's what you do in a major incident, for example.
5. What will the nurses in minors do? (Will there be any nurse in
minors?)
Same as now, working alongside the doctors.
6. What will the SHOs do?
I do have an issue with the SHO (and, since it was mentioned, SpR)
training and experience. We are developing a real supernumary SHO post
at the moment - an SHO week where the doctor is only working with the
shop-floor Consultant/year 4+ SpR. This shoould address some of the
training issues.
7. Is there any evidence that triage and division of roles (one triages,
one sees and one treats) is the major responsible for the lengthy
waiting time? Have other possible causes been excluded?
By waiting time I shall assume you mean waiting to see the first
clinician. This is multifactorial, and depends on rate of attendance,
staff numbers available, index of difficulty and time taken for each
problem for each patient (and we need to develop indices of this; a cut
finger needing an elastoplast being a low measure for doctor/ENP and
nurse and a trauma call being at the top end for each)and so on. A
single solution is not really applicable.
I should be most interested in the opinion of other list members.
M. Della Corte
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