----- Original Message -----
From: "Dunn Matthew
Subject: Re: See and Treat
> What is the point of this list if not to waste time in academic
discussion?
Correct, but time spent on academic discussion is rarely wasted...(well,
maybe occasionally).
> The government plans to make money available for see and treat by is
> willing to be swayed. In which case it's worth considering the evidence;
and
> as much of the evidence is currently unpublished I would consider that
this
> list is an ideal place to discuss it.
Yes, anecdotal or "situational" evidence must be just as valuable for these
issues.
> The DoH wants to reduce waiting times by the most cost effective method
> possible. In which case intellectual discussion is very much important.
Most
> of what we know on reducing waiting times comes from working in different
> departments or trying things in the long term in our own departments.
> Strangely, this may be the best evidence as it is less likely to be
> influenced by the Hawthorne effect.
Just for academic interest Matt, could you give me the background on the
Hawthorne effect? Who was this guy and what did he show?
> For example, in my experience, departments that don't allow inpatient
> specialities to clerk patients in their departments seem to have much
> shorter waiting times than departments that do. No published evidence, but
> its an interesting thought.
That's fascinating, but are these patients then directly admitted by
emergency physicians, or just seen briefly by admitting teams? Can you
expand further?
> There are a number of possible ways of reducing waits other than see and
> treat. Some of these have published evidence, some have been discussed on
> this list. Examples are:
> 'appropriate care'
I think you've explained this one already Matt.
> empowered triage
Tell me more...?
> fast tracking, streaming,
I think I've got those sorted in my head Matt.
> increasing the distance patients have to travel to A and E departments
I love this one; I think I'll move my department to the Cairngorms!
> offering booked appointments to lower triage category patients
Not sure about this Matt, the patients will definitely "punish us" this way,
and the GPs will have nothing left to do...unless the booked appointments
are with the primary care physicians who already work in our departments.
> bypassing A and E with certain categories of patients
You mean GP-accepted patients going straight to the ward? (full circle, was
routine in the "bad" old days)
> item of service payments to GPs for minor injury treatment, charging
patients.
Too political, especially the latter.
> Sure, work with the system, but we are in a position to influence things
> (some members of this list more than others). Triage was brought in (and
may
> be being thrown out) partly on the advice of A and E consultants.
I seem to recall triage was only brought in as a way of satisfying the
patient's charter at the time. I don't think A&E consultants were convinced
about it back then.
> Speed and quality can go hand in hand.
I must agree, albeit reluctantly, four-hour waits in A&E are depressing,
regardless of how brilliant the outcome - that's human nature.
AF
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