http://www.doh.gov.uk/performanceratings/2003/
Martyn,
We have done most of the initiatives you outline locally, which is no doubt
why our performance has been good in the past. See Web Site above for
Morecambe Bay.
My concern is that there is increasing demand being put on A&E with exit
block (no beds) occuring at the same time. Clinical Decision Units are a
fine idea, but I've also heard of them being used to fudge the figures....
"this patient is about to breach 4 hrs so let's put him on CDU".
I've heard it said that to avoid bed problems a hospital needs to be aiming
for 85% bed occupancy, perhaps A&E also needs a target for resources in
place to avoid prolonged waiting times.
Where do you work by the way?
Ray McGlone
Lancaster
----- Original Message -----
From: "Martyn Hodson" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, January 04, 2004 5:40 PM
Subject: Re: The 98% target
> ----- Original Message -----
> From: "Danny McGeehan" <[log in to unmask]>
> To: "Martyn Hodson" <[log in to unmask]>
> Sent: Sunday, January 04, 2004 8:26 AM
> Subject: The 98% target
>
>
> > Ray
> > I have been totally opposed to this nonsense since it was mooted approx
18
> months ago. It is totally unacheivable and >like you our dept. was
hitting
> targets of 90% last year and we are now going backwards and as low as 70
and
> 80%. The >reasons are twofold, lack of beds and excess demand on the
> service.
>
> lack of beds is a realistic reason, this is the reason most of the
breaches
> (not covered by the exceptions list) happen where i work, that and tardy
> appearances by specialities once referred (unless X ray are having a
really
> bad day)
>
> blood results were a problem until we stamped our feet hard enough to get
> the system the labs use piped up to us ( now get results 'directly off the
> analysers' to quote the labs IT bod )
>
> 'demand is related to staffing, work rates and the working practices of
the
> dept
>
> by working practices, the issue of 'Nursing staff waiting for the doctors
> to catch up', rears it's head and here are my thoughts on the subject as a
> Nurse , it's down to all the 'PDSA' stuff from collaborative etc
>
> -who cannulates in your dept ? ( and , if it's nurses, what percentage of
> the Nursing staff are competent?)
> -do you have an established policy of 'pre emptive' blood sampling /
> cannulation on the basis of groups of presentations ?
> - are other investigations ordered premptively ( 12 lead, urinalysis,
urine
> B-Hcg)
> - do you have nurse requested x-rays as well as ENP services ?
> - do your Nurses Suture?
> - do your Nurses Plaster?
> - are notes / previuous A+E records requested pre emptively ?
>
> are the doctors prepared to muck in with 'nurses jobs' if it increases
> throughput ? ( , i've had speciality SPRs making up the numbers in (non
> trauma team) log rolls before, sadly not every doc is or can be as
obliging
> as that.
>
> > Unfortunately the nursing staff are now being bullied to prevent
patients
> breaching as they are being leaned on from higher > management.
>
> usually it's the reverse where I work, we are badgering the bed managers
and
> Clinical co-ordinators to sort out beds, the higher ups act all concerned
> when they have to but i don't think they pressure us, but maybe that's
> because when things run smoothly we have proved sustained runs of high
90s
> % is achievable
>
>
>
>
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