Long waits for minor injury care are a national
disgrace and at long last our beloved government is
willing to address the issue. I'm delighted. Only
someone who has never waited in a full waiting room
with an injured child could fail to find this an
important issue.
One thing that annoys me though is that we will be
allowing HMG to take the credit. Who thought up all
these measures to improve the care of minor injuries,
such as ENPs, streaming and see and treat? Not
politicians, I'll bet. ED Consultants probably - who
else could it be? Where's the acknowledgement?
(instead we are portrayed as greedy fat cats who
oppose change and modernisation......drone drone)
I personally am very pleased that the gov are pushing
this as I have tried to go down this road for a few
years but was thwarted - mainly by that vast
monolithic structure called triage, which became a
self perpetuating monster in the late nineties. Nurses
grew to like it as it gave them a platform upon which
to develop a skill in assessment. Thankfully,ours are
forward thinking enough to see that it has to go.
We have been experimenting in Frenchay with our
version of see and treat (sorry, not made it to a
roadshow yet)and 'go live' in early december with our
new minors system 12hours a day, 8 at weekends.
It involves
no triage (hooray)
ENP/ Doc /junior nurse
plus physio/second doc at times
this team simply see n treat, divvying up the
patients according to their skills, to avoid
duplication.
Eyeball Assessment and allocation to stream replaces
triage and takes seconds usually, eg
Abdo pain - take to majors
paed minor HI - minors doc
arm injury - ENP
wax in ear - GP
damaged artificial nails (Alan montagues & my
favourite)- self care
Its not rocket science guys and sure extra staff would
be useful (we were all given hundreds of thousands of
£ last year for ENPs) but give it a go - we think
massive time savings can be had with the same staffing
levels by cutting out the duplication.
It is necessary to get started before a queue builds
up in the morning.
There are issues around the doctors role - a senior
doc is best as can authoritavely quickly and safely
reassure and discharge. So can a good ENP. You need
two seniors on a shift if you put one soley in minors.
SHOs...useful in this system when more experienced but
in the first few months will need a lot of support.
Steve Meek

--- John Chambers <[log in to unmask]> wrote:
> Some of the judgemental attitudes of older ( and
> some younger!) Emergency Physicians never cease to
> amaze me
> The fact is that the timeliness of providing care in
> Emergency Department is a real measure of quality
> both as it is perceived but also indirectly its
> delivery
> I certainly am very cynical about streaming , self
> care,nurse practitioners, consultant Triage and "see
> and treat" as offering the solution - ED's simply
> need better resourcing in terms of space and staff.
> Alternate providers should "pull" patients to their
> service rather than have patients "pushed"
> reluctantly in their direction.
> I do not live in a land of fantasy but it is hard
> work getting the message across
> I am sure most who work in EDs have the greatest of
> respect for all of their patients and their reasons
> for coming to the ED. They should not be subjected
> to prolonged waits once they get arrive.
> JohnC
>
> -----Original Message-----
> From: Alan Montague
> [mailto:[log in to unmask]]
> Sent: Tuesday, 26 November 2002 10:08 p.m.
> To: [log in to unmask]
> Subject: Re: See and Treat
>
>
> "Society based on equality"??
>
> This ideal has existed in men's minds for millenia
> and
> will never be more than an ideal. Our politicians,
> less naive than us, find it a splendid smoke screen
> for their mindless tinkering with our public
> hospital
> system.
>
> In emergency departments we help provide a service
> free at the point of delivery. There is no penalty
> for
> abuse of this service and inevitibly demand for it
> will increase. It is only restrained,sadly, by the
> delays we are now trying to remove. As we now empty
> the waiting rooms so will they fill up in the
> future.
>
> The only remedy can be by the exercise of firm and
> fair professional judgement controlling access to
> our
> service.
>
> I don't see this happening now. Our complaint driven
> hospital management culture has been sucessfully
> installed over the last decade. It takes too long to
> answer complaints and there have been too many
> suspensions. The GMC's disciplinary ambit is
> expanding
> rapidly as evidenced by its decisions and the
> expansion of its code of conduct. Yes we have always
> needed to be competent and kind. Now we must be nice
> as well. We should have jumped in and sorted it ten
> years ago.
>
> An effective gatekeeper must be given power,
> judgement
> and impartiality (as well as the golden tongue of
> persuasion and reassurance).
>
> Incompatable with the present version of "equality"
> imposed upon us.
>
> Alan
> (a lurker no more)
>
>
>
>
> --- José_Angel_Jarne_Navalon <[log in to unmask]>
> wrote:
> > Hello, good morning to all from Spain:
> >
> > I want to send my first message to the list.
> > I consider that, it is certain, the doctor's work
> > and of the nurse it should
> > be complementary and simultaneous. In many
> > occasions, the doctor, thanks to
> > their academic and scientific preparation, he can
> > carry out the work from
> > the nurse to the perfection, and the nurse, due to
> > their experience, also
> > this qualified to exercise the medical work.
> > It only separates them the law, a normative one
> that
> > in numerous occasions,
> > it is old and derailed in the time.
> > I believe that the moment has arrived of to unify
> > and to supplement both
> > sanitary professions. To my it doesn't fit me
> > doubt, both should be
> > complementary, mainly in the Medicine of Urgency.
> > But I trust that the step of the time and the
> change
> > of mentality, inside a
> > society based on the equality, will achieve this
> > goal so important for the
> > sanity in any dimension that was located. Plus
> > still, in the Medicine of
> > Urgency.
> >
> > Cordial greetings from Spain:
> >
> > José A.
> >
> > -----Original Message-----
> > From: Accident and Emergency Academic List
> > [mailto:[log in to unmask]]On Behalf Of
> > Adrian Fogarty
> > Sent: Monday, November 25, 2002 3:13 AM
> > To: [log in to unmask]
> > Subject: Re: See and Treat
> >
> >
> > Lots of good points Marcello.
> >
> > Waiting times, they're not just about waiting to
> see
> > a clinician, as a
> > patient can often spend a further hour waiting for
> > treatment from a nurse,
> > and don't forget a further hour waiting for
> > pharmacy. See and treat, I
> > suspect, will try to resolve this fragmentation.
> It
> > might actually force
> > doctors and nurses to work together as a real unit
> > again. It's gone full
> > circle in my career; I started out working very
> > closely with the minors
> > nurse, who used to prepare the patient for
> > examination, set up for suturing
> > (for example), assist, do dressings, advise,
> > document, etc. The modern A&E
> > nurse figures that this is a bit too
> > "handmaiden-like", and she prefers to
> > let doctors work alone, while she keeps a polite
> > distance*. I now call the
> > patient from the waiting room myself (if the
> > patient's still there), find a
> > cubicle (if one's still available), prepare them
> for
> > exam, bring them to
> > theatre, set up for suture, dress the wound,
> > document, advise etc. And for
> > the things that need nursing input, there's
> further
> > delay and inevitable
> > communication problems, as I rarely meet the
> minors
> > nurse now! Basically I
> > spend well over 50% of my time in minors doing
> > non-medical tasks that could
> > be done better by a nurse or an assistant. Now I
> > wouldn't really mind this
> > if there wasn't a 4-hour wait just to see a
> doctor.
> > Basically I could be
> > twice as productive if the culture could be
> changed
> > back to the way it was
> > (points noted Ray). So to return to one of your
> > points Marcello, there's a
> > definite role for the minors nurse in "see and
> > treat", and I see it as right
> > next to the physician.
> >
> > Other points: as our minors waiting times reduce
> > we're going to see
> > interesting spin-offs and side-effects. On the
> > positive side it's much
> > easier to deal with a "reassurance" case if you
> see
> > them in 30-40 minutes
> > rather than 3-4 hours. Try telling a "punter"
> > there's nothing wrong with
> > them after they've waited 4 hours and you'll get
> > grief. But tell them the
> > same thing after 30 minutes and they're quite
> > relieved! Secondly the "Bevan"
> > factor will kick in; as patients get wise to the
> > rapid turnaround in A&E,
> > they'll not bother with their GPs anymore (and who
> > would blame them);
> > they'll head straight for A&E, and this will tend
> to
> > offset any advantage
> > we've gained.
> >
> > Interesting times...
>
=== message truncated ===


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