So Matthew Cooke from Warwick says it will never happen and Matthew Dunn
from Warwick has been trialling the idea. Any comment from Alistair
Campbell?
-----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 June 2003 14:53
To: [log in to unmask]
Subject: Re: Scary rumour
> 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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