I may have the wrong end of the stick...but if they
fail observation ...that means they need in-hospital
care usually....ie trop +ve....or other pathology
identified. We admit them to approp team....it is an
issue in terms of finding a bed etc.
So clock then stops from our view point...is that what
you wanted to know....probably not?
Other groups either get planned re-attendance...small
group of ?DVT patients only now...and some pleuritic
chest pains. Seen in clinic
Some re-attend regularly...DSH.....and some chest
apins...who either get fedback to GP or to cardiology
if concerns
hope that helps
Taj
--- Katherine Henderson <[log in to unmask]> wrote:
> 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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> >
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