> Patrick Nee claimed at the RSM meeting today that once the
> Government had got everyone streaming like noses with hay
> fever (estimated
> 2005) they would drop the limit to 100% out in 2 hours.
>
> That really would be the death of Emergency Medicine. Anyone
> have any more information?
Not much in the way of information. However (probably because of our
performance on the 4 hour target), we were asked to look at how we could hit
the 2 hour target, and offered some cash if we could keep to it over a set
monitoring period of a few months. There would be a number of agreed
exceptions e.g. patients requiring sedation or regional anaesthesia;
patients- mainly the seriously ill- in whom early transfer to an inpatient
area would compromise their care; and patients requiring a period of
observation. There would be scope for justifying any breach of the 2 hour
target retrospectively. I think its more likely that a few places are in our
situation of looking at how to do it rather than it being a full on roll out
nationally at a set date.
We built a bit on the work with the Warwick Manufacturing Group. Basically,
a 2 hour target was achievable but pretty expensive for us- more doctors,
clerical workers and secretaries and a heavy impact on the labs and on
radiology; extra IT equipment; physical extension of the department. The
extra money on offer was insufficient.
Quite an interesting paper exercise though- made us think outside the box a
bit looking at inefficiencies. The conclusions we drew were applicable only
locally and it may be that other departments could hit 2 hours cheaper. But
basically, with additional resources and given certain exceptions (quite a
lot of them) a 2 hour target is achievable 99% of the time (I never like
100% targets) without adversely affecting A and E patient care. There would
however be quite a lot of knock on to the rest of the hospital.
One thing that came out of the modelling is that while a modest increase in
doctors (and use of more nurse practitioners) will help achieve the 2 hour
target, the main focus has to be on increasing the efficiency rather than
the number of doctors. I think it is unlikely that there will be the
political will to put the necessary resources in place.
I don't think there's too much of a threat to emergency medicine from these
targets provided we clarify which patients need to be exceptions (mainly the
1- 2% of most seriously ill patients), work with a separate clinical
decisions/ sieve area (under A and E or under someone else) and keep
procedures and recovery separate (i.e. in appropriately comfortable and
private beds with adequate monitoring). The advantage we gain is that we
don't have inpatient teams sending their juniors down to make admission/
discharge decisions and we get support from radiology and labs if it is to
be workable. Needs a lot of resources to improve though.
Matt Dunn
Warwick
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