> I would take precisely the opposite view. Many of the people
> coming into Emergency Medicine
> now have the skills and interest to take on this important 4
> to 24 hour period.
To me or to the RCP? Personal interest: Lead consultant for medical
assessment unit/ admissions ward (the former is the official title; the
latter the more accurate description). Have the interest, like to think I
have at least some of the skills. Although unless we get more staff, I'd
still prioritise the physiologically unstable and complex minors higher; and
pass the "CDU" stuff onto another speciality.
> We do need to look to
> protect our speciality - there are those who look to the Euro
> polyclinics where nurses see all the
> minor stuff and call people down from elsewhere for
> everything else. We are probably kissing
> goodbye to all the treat and street (Group 1) stuff, slowly
> but surely, much as obstetricians don't
> do uncomplicated deliveries.
Sure, but I don't think we can neglect the minors side altogether- there's a
lot of complex soft tissue injuries out there that would benefit from
consultant input. Especially if we develop our ultrasound skills a bit
further and invest in high frequency linear array probes. Personal pet
project there.
> Our own figures show that Emergency Physicians are more
> prepared to send patients home at
> under 24 hours than Internal Physicians with a reduced risk
> of reattendance,
Our system doesn't really work for comparing the two. What is interesting is
that as we've expanded consultant input (particularly on the trolley side),
the number of admissions has increased. And the last audit we did showed
they pretty much all required admission. So hopefully safer practice, but I
have my doubts about sending more home- unless you mean by changing the
philosophy to running a 6 hour rather than a 36 hour assessment ward.
Personally I agree with the sentiment that acute medicine fits better as a
specialisation of emergency rather than general medicine. (Also, you need a
consultant for the non medical stuff as well, so you'd need to double up on
call if it's general physicians). I don't see the RCP stuff as threat partly
because of the practicality- I just don't think there are enough physicians
who want to do this (and even those who do seem a big cagey about doing it
in the early hours). I think a consultant based service for critically ill
patients will have to come from a mixture of A and E, medicine, ITU and
possibly other specialities. It is possible that there will be enough RCP
acute physicians to run EAUs in terms of 12/ 7 presence, ward rounds,
assessment of stable patients etc.; but I don't see them doing the
overnight. In terms of resuscitation facilities, the evidence is so clear
that it approaches (Bolitho rather than Bolam) negligence to move most
medically ill patients out of the ED prior to stabilisation, so there will
be little experience of the critically ill patients for these consultants
unless they form an active part of the ED team.
Matt Dunn
Warwick
This email has been scanned for viruses by NAI AVD however we are unable to
accept responsibility for any damage caused by the contents.
The opinions expressed in this email represent the views of the sender, not
South Warwickshire General Hospitals NHS Trust unless explicitly stated.
If you have received this email in error, please notify the sender.
|