Having sorted out the OOH nurse call handling (to some extent - thanks for
the replies), I'm now making recommendations about the handling of
paediatric emergencies locally and would like opinions on the following:
-Accident and Emergency Department
-30,000 patient catchment area
-Consultant in charge in one of the local Surgeons (not A&E trained)
-No middle grade cover
-No external A&E input from other departments
-Dedicated A&E nurses with some PALS trained
-No dedicated SHOs - dept covered by surgical SHOs on 1:4 rota
-Most SHOs have little or no A&E experience
-No paediatric services on site
-Nearest other A&E/paeds unit is 3 hour drive from dept (roads closed for
1-2/52 per year due to adverse weather)
-Physicians on site have issued statement that they do not provide paeds
cover under any circumstances.
-Dept has no formal policy of paeds emergencies
-Recent critical incidents involving nurses 'phoning round' for GP and/or
anaesthetist to help stabilise seriously ill paeds cases brought by 999.
-Maternity unit threatened with closure recently due to lack of paeds cover
but reprieved after vociferous local opposition to closure
My recommendations are:
1. Local GP on call should cover medical paeds emergencies and should have
one week per year paid paeds training (PHPLS/PALS minimum)
2. SHOs should receive APLS training minimum to cover trauma cases
3. Anaesthetists should be formally involved in all resuscitations and
should be APLS certified.
4. GPs should have integrated access to A&E facilities without need to seek
authority from physicians (eg: xray, vitals, written rx plans)
5. Cover for maternity unit should be included in the plan
6. Appropriate remuneration for the GPs and funding for training/equipment
must be provided by the trusts concerned.
In the mean time I'm concerned about the use of the term 'Accident and
Emergency' to describe the dept.
(It is my view that if you tell patients that you are an A&E, then you need
to be able to provide a proper A&E service).
Could I ask for the following advice:
1. Are my recommendations for paediatric cover sensible?
2. In view of the lack of formal medical A&E input what steps should be
taken to ensure the safe running of the dept?
Thanks in advance for your help.
--
Dr Robbie Coull
R.K. Coull Ltd MB ChB, DipIMC RCSEd
Locum Doctor Service BASICS Immediate Care Doctor
INVERNESS - SCOTLAND ALS / PHPLS Instructor
email [log in to unmask] telephone 0777 492 7757
website http://www.coull.net fax 0704 407 3033
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