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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