You obviously have radiologists who have sorted their WTD stuff out.
Ours seem to be in at all hours - I have to say they are in at least as
much as A&E doctors.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: 06 July 2003 19:52
To: [log in to unmask]
Subject: Re: NICE Head Injury Guidance
> Little support on list so far for NICE guidance.
> So do you implement, or not?
> If you do, system breaks down due to predicted 75% increase in
> requests
[Goat]
Am not convinced the system will "break down", Goat. In most hospitals
in this country, CT scanners lie idle after 5.00pm, and radiologists get
paid handsomely for being "on-call" from home. Most of our demand for
this investigation occurs after 5.00pm. Seems to me the obvious solution
is to make radiologists resident (and working) while on-call, in the
same way that every other acute speciality is!
> Indeed there was a suggestion during the week at BAEM council that the
> guidleines could replace Bolam, though my recollection from UK law is
> that Bolam has already been passed over by Bolitho. [John Ryan]
Guidelines have always been accepted by lawyers as providing evidence to
support best practice. Guidelines are already used to support the
advocacy of litigation, i.e. they have not "replaced" either Bolam or
Bolitho, they merely assist the court in defining what is acceptable
medical practice. However, under Bolam you could get away with working
outside guidelines, if enough of your colleagues disagreed with them,
for well argued reasons. Under Bolitho it is much more difficult to work
outside guidelines, although technically speaking you still can if your
arguments are persuasive enough. For example, I would imagine many
emergency physicians agreeing with the "Perth 4 hour rule" on ethanol,
even though NICE is suggesting 2 hours. We just don't know at this stage
if courts are going to accept arguments outside the more established
"guidelines" that are now coming through. But I suspect they will,
especially where there is (acknowledged) poor evidence underpinning
various aspects of these guidelines.
> We actually scan people not to know if they've got an ICH etc or not -
> but to be able to safely send them home obviating the need for neuro
> obs and blocking up the ED...[Paul Bailey]
Precisely, this is where we've got to move away from the simplistic idea
of doing tests only in the hope that they might be positive. A negative
scan is probably more helpful than a positive scan, in terms of changing
management.
Adrian Fogarty
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