Yes, eyeballing majors and formulating a management plan, so you can get
their bloods and x-rays underway (for example) is what we call "front
loading" of majors. When the SHO sees them 60 to 90 minutes later, all the
"evidence" is ready for them, leading to what I call the "compact
consultation" i.e. the history, exam and investigations are all available at
the same consultation. This not only speeds the process up, but it should
reduce the handovers/forgetfulness/confusion that often occurs when you're
juggling four or five majors at once!
And the speed advantage is compound. For example you might expect that a
1-hour wait to see the doctor, plus a 1-hour wait for bloods, should equal a
2-hour wait for decision/disposal etc. But it doesn't, as when the bloods
come back at the 2-hour mark, the treating SHO is usually now involved with
another case, and he therefore doesn't "catch up" with his first patient for
up to another hour. So now the case becomes a 3-hour case, and so on, with
yet more potential for errors on top of the delays. With "front loading" it
could easily be a 1-hour case, and less stressful for the patient and the
SHO.
The term "front loading" was, I believe, originally applied to how we can
influence length of hospital admission by what we do in the ED. Basically,
if we "over- investigate" in the ED, it's recognised that the patient's
overall admission time to hospital will be reduced. At its most basic level,
we get investigations and decisions quickly in the ED environment when
compared with the ward. The ward patient has a 24-hour decision "cycle"; day
1, let's order a scan; day 2, any word of the scan yet; day 3, scan back,
let's formulate a plan; day 4, check on plan's progress; day 5, think of
discharge. If that scan had been done from the ED, the patient would go
directly to "day 3" of their hospital admission, with a prospect of
discharge several days earlier.
But "front loading" majors isn't exactly the same as "see and treat" of
minors, as the latter implies that you eyeball them and completely sort them
at the first consultation. One of my main criticisms however is that many
minors cannot be sorted in one consultation, many are just as complex as the
majors, albeit in a different way. They often need "front loading" too,
usually by x-ray, but there are also other things that need sorting before
you can finish the consultation. Isn't engineering fascinating...
Adrian Fogarty
----- Original Message -----
From: "Cliff Reid" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, December 15, 2002 2:24 PM
Subject: Re: trick or treat
> Does see and treat apply to all-comers or just to minors? Surely majors
> patients would benefit from a senior eyeball on arrival so that an
> investigation/management plan can be initiated?
>
> Cliff Reid
>
> _________________________________________________________________
> MSN 8 helps eliminate e-mail viruses. Get 2 months FREE*.
> http://join.msn.com/?page=features/virus
>
|