--- "Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY -
SwarkHosp-TR" <[log in to unmask]> wrote:
> This is the problem for the patients- there seems to
> be pressure on using A
> and E doctors for avoiding admissions (i.e. sieve,
> do the workup according
> to someone else's protocols, do the out of hours and
> take responsibility for
> inappropriate discharge) while the physicians etc
> take on the sicker
> patients (unfortunately, although many physician
> consultants aren't
> interested, they do like these patients to be under
> my juniors).
> This emphasis on A and E consultants to keep down
> time in A and E suggests
> that I may be left sieving the patients and passing
> on anyone ill to an SHO
> at an early stage. Not good for personal enjoyment
> or patient mortality, but
> as Mr Milburn says, what the public consider
> important when it comes to
> electing politicians is the waiting time in A and E.
> The problem is that if
> A and E consultants are seen as working as juniors
> to inpatient teams it
> does the image of the speciality no good.
While I agree that admission direct from triage is one
of the streams I don't see this as something for
acutely ill patients. I see it as something for
conditions that obviously require specialist input,
but don't need urgent intervention. Things like
epistaxis where there is no point in them sitting
around for a couple of hours waiting to be seen by an
A&E SHO only to be sent to ENT. Might as well go
straight from triage for their cautery. However I
intend to write the protocols for this - not leave it
to the other specialties.
>
>
> There is, unfortunately this 100% 4 hour target,
> which makes it rather
> difficult to sort your more complex minors (makes
> GAs in A and E pretty much
> impossible and most regional techniques fairly
> difficult). The easy way to
> hit this target is to use your consultants for speed
> dealing with simple
> minors and pass on any patient requiring admission
> or more complex problems
> to other specialities so they get out of the 4 hour
> period asap. Properly
> resuscitating septic shock, spending an hour
> suturing a face or using
> regional anaesthesia takes you out of this. I have a
> genuine worry that we
> are being pushed into having sick medical patients
> dealt with by medical
> SHOs, manips done by orthopaedic SHOs etc.
A few points here. As I understand it the model for
emergency care includes primary care and assessment
units and free flow of patients between these and the
A&E unit so your manips, medical cases requiring
workup etc. would go to the assessment unit, but not
neccessarily referred to another team. As for other
specialties taking on more work again I don't see it.
None of them are queuing up to take on more things
quite the opposite - they want us to more and more. If
I were to suggest that the orthopods did all the
manips there would be a riot!
Cheers Fred.
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