We simply staffed our discharge lounge with a promotion from the ED - meant
we lost a valued staff member, but we trained in another interested one to
replace her. The Discharge Lounge person now prowls and hunts for
discharges. If we find a block incidentally and inform her - she will try
and persuade the ward nurse manager to release the patient to her. Has
undoubtedly made a difference - but only marginal.
I was fascinated with the earlier post (deleted without replying, so I can't
remember from whom) which talked about "down to 2 majors cubicles free ---
down to none". In our department, we have labelled all our cubicles as 1a,
1b 2a,2b etc. We double up EVERY day - 60 cm between the trolleys -
wouldn't want to be a big clinician!!
We even have numbers on the walls of the corridor, so as to be able to
identify where the patients are, as we used lose so many.
[note for all those with superstitions - no number 13!!. Most weeks, we
disrupt Fracture Clinic and Orthopaedic clinics by placing 4 or 5
in-patients in the Plaster Suite.
All the in-patients are nursed by a separate cohort of nursing staff - some
ours, some agency. We even ahve an In-patients' Chart Trolley, like on the
wards, where everything is held centrally - again for reasons of patient
safety and staff efficiency.
Our belief is that things are disimproving, rather than improving, despite a
nationwide Emergencyy Nurses strike last year, which led to lots of
political flack, a two day seminar that produced a 3 cm thick report (all
copies of the set piece presentations and of the flip-chart contents from
the buzz-groups - marvellous waste of time and money)and a promise of
reforms to admission /discharge policies and a review of nursing levels in
all EDs throughout the country. Said review is still ongoing and, as it is
seems to be based on a UK - NHS model, is not likely to be of any great
value to us. There is still some tension in the air - happily less in our
department than I perceive to be th ecase elsewhere, with rumours of repeat
industrial action surfacing from time to time.
Well, we'll soldier on - remember that SHO changeover in the Emereld Isle is
at 8am on January 1st - Good Luck, JR and all the other Irish guys/gals on
the list. I'm going to be ON LEAVE (thanks, Ger - hope I've left the place
intact from the Christmas rush)
Off to see my seven in-patients
Happy New(?) Year
Patrick
-----Original Message-----
From: Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR
[mailto:[log in to unmask]]
Sent: 30 December 2002 09:08
To: [log in to unmask]
Subject: Re: A & E reforms
> Blimey! Surely takes ages to identify them accurately.
> Top marks if you find it works. Should we pay ward
> nurses a bonus for discharges on their shift?
Yes. Or if you don't like that, how about a discharge lounge where the staff
are paid by the patient they get through so they go round the wards hunting
for patients. Or if you really don't like to make it financial, just a
discharge lounge where if the staff can get all their patients in and sorted
first thing in the morning, they should be out before the end of the shift,
so a quiet time for them. But basically something that ensures that
discharging patients early and appropriately is a benefit rather than a
problem for those people empowered to do it. (Same thing with anything you
want done- unless there is someone who is able to do it and will benefit
overall from doing it it is unlikely to get done. And no amount of setting
targets, sending out memos, creating policies etc. will change that).
Matt Dunn
Warwick
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