> There is a system (albeit much underused in Ireland)that
> allows for patients to be accepted for assessment/admission
> by specialties other than emergency medicine, using the
> emergency department as a reception area to allow these
> patients and the accepting consultant or delegated person to
> meet. Unless I need to intervene in an emergency, I am of
> the impression that I have no business interfering in a
> contract (however vague) between the patient/the general
> practitioner/the accepting consultant. I think to do so,
> unless invited by the responsible consultant, could be
> interpreted as professional misconduct.
Depends a bit on the set-up. In Leeds General Infirmary all patients
(accepted or not) were under the care of the A and E consultant who had the
right to admit to wards under inpatient consultants. This addressed the
issue of the patient needing treatment in the ED but not being an ED patient
and the 'accepting' team unavailable for comment.
I think though that there is some evidence that while the 'accepted patient'
system as it stands in most places works well enough for the less ill
patients, critically ill patients are ill served by it- it may be to our
benefit to draw from the US model and screen all patients on arrival with EP
involvement as well as the admitting team in those with the potential for
serious illness.
>
> I am very concerned that ther may be an implication that I
> would somehow become responsible for the repeated assessment
> of the ever present numbers of "yesterday's patients" (i.e.
> ones that had their emergency assessment at some previous
> time but are still in the emergency department because of the
> lack of unoccupied beds).
In my mind this is a bit of a different issue. It is entirely consistent to
argue that EPs are more trained and experienced in resuscitation and
emergency treatment of the critically ill patient in the first 12 hours (or
1 hour or 24 hours or whatever) than subacute general physicians, but that
the subacute general physician is better at picking up the problems that
don't kill the patient overnight but still need treating.
>
> I would currently feel that if it is obvious to me that such
> a patient has a requirement for immediate management, or if a
> member of the nursing staff informs me that they believe the
> patient needs me to intervene as an emergency, I should do
> so. However, I do not feel I can be held personally
> responsible for the routine management of another
> consultant's patients because, through no fault of the
> patient's, they just happen to be interfering with my ability
> to see the nest patient.
>
> Have I "got the wrong end of the stick?"
No- I've looked at this in the past and can't find any definite legal
clarification in the UK. Ultimately if something goes wrong, the hospital as
a whole is liable and probably won't put too much effort into apportioning
blame between departments. The GMC (in the UK) is unlikely to take action
against you for not dealing with a patient who had been referred (although I
suppose if someone was to take the attitude that they would have nothing to
do with other peoples patients despite repeated pleas from nurses it would
be different). If you are a trouble maker and your hospital is looking for a
reason to suspend you, I've heard of suspensions on flimsier grounds.
Matt Dunn
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