> According to this document a consultant in a department with
> more than 3 consultants should see about 800 patients a year
> if they do 5 PAs on the shop floor.
>
> According to my calculations, and I'm ready to be corrected,
> that's about 18 patients a week (800/44), or 4 patients per
> PA, ie 1 an hour.
>
> What does the list think of that then? Too much, not enough
> or just right?
>
Depends on what the consultant is seeing (which the document addresses). A
consultant working like an old style SHO should be able to see more.
However, these days, a consultant can do a lot more. Spending only an hour
with a critically ill patient seems a bit short. Even on the "simpler"
patients, compare it to other specialities- most consultants in subacute
specialities allow between half an hour and an hour for new patients even
when they come with a GP referral. In A and E it's a bit more complex as the
patients are much more unselected. Also, we often do more than is sometimes
done. When I was a physician we didn't review blood results at the first
appointment (I accept that many physicians do these days). In A and E it's
not uncommon to send off and review investigations at the first consult,
perform procedures (including minor operations, sedation and regional
anaesthesia), report plain films (BTW, anyone seen the RCR paper on
radiologists' workload- anything up to 1 plain film report a minute, which
seems pretty impressive to me), carry out ultrasound scans. I'd guess that
this is about right at present; but with the expanding role of the A and E
consultant the rate at which patients can be seen is likely to drop.
Accepting that, I'd say that the rate is a reasonable one for the time
being. As A and E consultant numbers expand, I would expect to see an
improved service for the sicker and more complex patients rather than a drop
in the numbers of other staff needed.
Overall, a good document. Recognises the role of an Emergency Medicine
consultant.
> If minor injuries nurses are supposed to be seeing the
> quicker cases i.e. the minors, it seems strange they would
> see less patients working more hours than a service middle
> grade working 5.5 hours who would mainly be seeing moderates
> and majors, if the minor injury provision is mainly done by ENP
A number of reasons one could think this way. At the moment, staff grades
work faster than ENPs in most departments due to greater experience. There
is also the point that ENPs often do more than staff grades (they often do
the "normal nursing" stuff as well).
> We recently studied all our SHO's and calclated the number of
> patients seen per hour in the department.
> Clearly it is a mix of majors and minors but the average was
> 1.5 patients per hour.
> The GP's and ENP's were best (only see minors) at about 3 per hour.
May be a casemix thing. I'd guess your GPs and ENPs were seeing a
disproportionate number of the simple minors leaving the SHOs seeing a
disproportionate number of the more time consuming cases. My own computer
system is not much good for data mining; but one thing that emerges is that
waiting times rise sharply when the arrival rate of patients exceeds 2.2
patients per doctor hour.
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