Here Rowley,
How about this one from that chap Rudyard Kipling from down your way at
Rottingdean bewteen Brighton and Eastbourne:
"Oh, East is East, and West is West, and never the twain shall meet,
Till Earth and Sky stand presently at God's great Judgment Seat;
But there is neither East nor West, Border, nor Breed, nor Birth,
When two strong men stand face to face, tho' they come from the ends of the
earth"
One of the messages coming through and re-inforced for me at Plymouth is
that See 'n' treat is not proscriptive and departments should cut the cloth
to suit themselves.
John Ryan
----- Original Message -----
From: "Rowley Cottingham" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, November 27, 2002 11:48
Subject: Re: See and Treat
> I was told about Sir George's remarks, but, cynic that I am, I simply
> thought of a certain previous speech.
>
> >From this day to the ending of the world,
> But we in it shall be remember'd;
> We few, we happy few, we band of brothers;
> For he to-day that sheds his blood with me
> Shall be my brother; be he ne'er so vile,
> This day shall gentle his condition:
> And gentlemen in England now a-bed
> Shall think themselves accursed they were not here,
> And hold their manhoods cheap whiles any speaks
> That fought with us upon Saint Crispin's day.
>
>
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of A S Lockey
> Sent: 27 November 2002 23:32
> To: [log in to unmask]
> Subject: Re: See and Treat
>
>
> 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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