----- Original Message -----
From: "Rocky"
Subject: Re: Head injury guidelines
> I fear you're correct, Danny although, as I work in a place with no Obs
Ward
> and Neurosurgery, it's not too bad for us at the minute. However, our
> general surgeons have already said they don't want to have head injuries
> (and the drunks who usually come with them) in their beds and I suspect
> we'll end up looking after everyone who doesn't need a neurosurgeon.
> Naturally, they will be the ones who make the decision as to who needs
them.
We were rather fortunate, in retrospect, Rocky. We've been "fully Galasko
positive" for the last two years, but without any increase in our own
workload, as the neurosurgeons effectively took on the work relinquished by
the general surgeons. It was partly because the neurosurgeons had twice as
many consultants and registrars as we had at the time, but it was also to do
with beds, and more specifically the type of beds.
Basically, prior to Galasko, we took the "minor heads", the neurosurgeons
took the bad ones, with the general surgeons everything in between, which
wasn't that much actually. When Galasko hit, we argued that our obs ward
couldn't take high dependency patients, and we didn't have resident
registrar cover anyway. The neurosurgeons on the other hand had resident
registrar cover, and although they were tight for "neuro" beds and provided
tertiary level care for several million, they could look after the "middle"
group of patients as long as they stayed in "surgical" beds.
So that is, in effect, what happened. We still take only the minor heads,
with neurosurgery taking the bad ones to ITU/HDU etc, but the "middle" group
now go to whatever surgical ward is free, but with neurosurgical input. We
therefore haven't noticed any increase in workload, and in fact it's had the
added benefit of streamlining our access to imaging. Essentially general
surgeons are no longer involved, and neurosurgeons don't want to discuss a
patient prior to scan (generally), so we now have direct access to CT via
radiology only.
I hope this is helpful, but as I said earlier, in retrospect we were
lucky...
Regards
Adrian Fogarty
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