Sorry, Katherine, now you've really confused me. What do you mean by failed
observation? If you mean someone who is discharged and who subsequently
reattends unexpectedly, then you cannot and should not call them a planned
review. If you do, then perhaps you are no longer a physician, but you've
become a politician instead! It's an insidious process, but apologies if
I've got the wrong end of the stick...

Adrian Fogarty

----- Original Message -----
From: "Katherine Henderson" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, June 17, 2003 9:56 PM
Subject: Re: AMI/CHD role


> Good to hear from you.
>
> Back to the old Observation Unit issue. How do you deal with the time data
> for patients who 'fail' observation. We have been rebooking them in as
> planned reviews. this starts them on a new time and got round the concern
> about unplanned reattendance figures jumping. Afterall while the aim is to
> get patients home some will not improve as expected.
>
> What do you do?????
>
>
> K
> ----- Original Message -----
> From: "Taj Hassan" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Friday, June 06, 2003 11:45 AM
> Subject: Re: AMI/CHD role
>
>
> > Katherine
> >
> > Congratulations on your new post. It sounds as if
> > common sense will begin to prevail on the more useful
> > targets.
> >
> > I share Bill's concern about more clarity from the
> > Centre on the disuse of the 20min target. I hope this
> > will come.
> >
> > We have just completed an RCT on the role of a
> > pre-hospital ECG on the call to needle time. We hope
> > to present the results at FAEM this year.
> >
> > Much can be achieved with this intervention alone and
> > 'red calling' ahead. I know that there are a number of
> > systems around the country who are moving towards
> > pre-hosp thrombolyiss and this may indeed be very
> > appropriate in the right settings.
> >
> > However with appropriate optimisation and Q.A systems
> > this intervention seems less likely to be useful as
> > compared to an ECG and rapid transit.....balancing the
> > risk-to-benefit ratio of thrombolysing in some very
> > stressful pre-hospital settings a few times a year or
> > less (average paramedic).
> >
> > The crucial message I believe is that EDs must work
> > closely with their pre-hospital care systems to
> > eliminate the 'easy' delays. I believe we still have
> > some way to travel there.
> >
> > Thanks for the update
> > regards
> >
> > Taj
> > Consultant in Emergency Medicine
> > Leeds
> > & Acting Head of Service Leicester (for another T
> > minus 24days :-)
> >
> >
> > --- Katherine Henderson <[log in to unmask]> wrote:
> > > Dear Emergency Medicine Colleagues,
> > >
> > > Some of you may remember that I sent round a mailing
> > > when I joined the national steering group of the CHD
> > > Collaborative - the operational spear of the CHD
> > > NSF. One thing always leads to another and I now sit
> > > on the Department of Health CHD Taskforce and today
> > > attended my first steering group meeting of MINAP
> > > (replacing Roger Evans who previously attended). I
> > > am the only Emergency Physician on these bodies so
> > > feel it is important that my colleagues are aware
> > > that I am there.
> > >
> > > Current hot themes are
> > >
> > >   a.. The 60 minute target is the one that counts -
> > > with a 10% improvement in this year on year from a
> > > base line which will be published with the public
> > > MINAP report in June.
> > >   b..
> > >   c.. A recognition that 20 minutes v 30 minutes
> > > does not make a huge difference but the 20 minute
> > > target still exists.
> > >   d..
> > >   e.. Concern that everyone needs to realise that
> > > the 60 minute target is only achievable with some
> > > pretty radical prehospital thinking. All the
> > > improvements have come so far from the in hospital
> > > phase. Hence the pre-hospital thrombolysis
> > > enthusiasm- the only alternative is much shorter pre
> > > hospital times.
> > >   f..
> > >   g.. A unclear commitment to PCI - massive concerns
> > > about cardiology numbers etc
> > >   h..
> > >   i.. A view that ACS patients are really the ones
> > > we will need to worry about - MINAP is starting to
> > > get some data but not done anything with it yet.
> > >
> > > If anyone at any point wants to raise an issue
> > > please let me know and I will do my best. I am
> > > pretty new to this level of discussion and am
> > > finding my feet. However being a female clinician
> > > who actually thrombolyses patients regularly does
> > > give me some unique characteristics and insights in
> > > the new exiting world of the great and the good!!!!
> > >
> > > Dr Katherine Henderson
> > > Consultant in Emergency Medicine
> > > Homerton Hospital
> > > [log in to unmask]
> > >
> >
> >
> > __________________________________
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> >
>