In my opinion care pathways per se are not the problem but it is a
problem if the care pathway determines that patients presenting with
certain emergency conditions simply pass through the ED to be seen by
juniors in some other specialty in some other place. There are some
groups of patients I enjoy seeing less than others but I refuse to have
any groups of our patients streamed off to be seen by "specialists"
directly when we are the specialists in Emergency medicine and the
"specialists" they are streamed off to see were my SHOs last month!
Care pathways that avoid duplication of work and multiple handoffs are a
good thing. They could lead to those that need admission being
identified early and a bed being requested so that after any necessary
urgent investigation and treatment they could go straight to a ward.
Streaming of some groups of patients past or through the ED has been
suggested by one or two managers in this neck of the woods. The A&E
Consultants are resisting this and we have the full support of our local
GPs in our preferred option which is to move in the opposite direction.
That is to funnel all emergency care through the ED and have a single
A&E Consultnat led emergency team.
Andrew Hobart
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Paul Ransom
Sent: 31 January 2003 11:02
To: [log in to unmask]
Subject: Re: Nurse led referrals in majors.
I must say that See and Treat is not dead in our minor injuries area,
but doing well at present under the auspices of a fierce and very
competent senior nurse who is dispatching inappropriate attenders (
yes, I mean that ) back to the street or their GP in a timely manner.
It has been a pleasure not to walk through a waiting room of glowering
faces for the past weeks.
BUT, the next initiative from management and upper nursing echelons has
been causing me some more concern: care pathways for the majority of
majors patients coming through, to be funnelled off to gynae,
orthopaedics, cardiology etc, after assessment by a senior nurse in
order to beat the four hour targets.
There are advantages of a senior nurse assessment around the clock, as
they can spot a problem early and involve medical input earlier.
However, it seems that in our eagerness to comply with 4 hour waiting
times we are doing ourselves out of a job. I can see 10 Emergency
Medicine SHOs in the near future twiddling their thumbs while the
majority of patients funnel straight past them OR lie in the corridor
waiting for the specialty doctors to arrive and see them.
This is not the way forward for Emergency Medicine. I believe we would
be expanding our roles towards total care of emergency patients that
come through the door, and many of these will take longer than 4 hours
to sort.
Any other departments undergoing similar initiatives ?
Paul Ransom
Consultant, Brighton
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Dunn Matthew Dr. (RJC)
ACCIDENT & EMERGENCY - SwarkHosp-TR
Sent: 30 January 2003 09:13
To: [log in to unmask]
Subject: Re: Trick & Teat is Dead/ Nurse practitioners
Thanks for the postings on these. Looks interesting. To take it a bit
further, what sort of absolute numbers is each NP seeing in the
departments
where they see a lot of patients?
Matt Dunn
This email has been scanned for viruses by NAI AVD however we are unable
to
accept responsibility for any damage caused by the contents.
The opinions expressed in this email represent the views of the sender,
not
South Warwickshire General Hospitals NHS Trust unless explicitly stated.
If you have received this email in error, please notify the sender.
|