Staffing is a major factor as is beds. We have changed a lot of what we
do such as the PAT system (patients assessed at the front door by a
senior doctor and nurse and moved swiftly to inpatient teams if
necessary), but we are frustrated that this breaks down easily under
overload - when of course it should be most useful. The middle grade who
is PATting gets tied up with sick patients and then PAT stops. This
suggests that there is not adequate redundancy in the system. We can't
easily do what McDonalds does - calls people in for short periods - as
there are issues around competency and skill retention.
We are predicting further problems locally in January with 4 middle
grade vacancies. Anyone want a nice senior clinical fellow job for a few
months? Email me.
However, one of the things we do not have a grasp of is how good our
staffing is compared to other sites of similar workload and casemix. We
know what BAEM thinks the staffing should be in the 'way ahead'
document, and I guess every Trust laughed at the recommendations.
Despite recent increases in staff we still feel understaffed,
particularly at middle grade. Is there any data on staffing available?
Best wishes
Rowley.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Dunn Matthew Dr. (RJC)
A & E - SwarkHosp-TR
Sent: 21 December 2004 11:14
To: [log in to unmask]
Subject: Re: Four hour waits and on-call
> I think the problem is the target is set too high. In times of peak
> demand (in the summer for Lancaster) the target won't be sustained
> unless patients are diverted away to the GP or told to come back
> later. As we are an open access service i.e. we don't give
> appointments like our local out of hours GP service... it's bound to
> cause problems with a 98% target.
>
As you say, it's a predictable peak. I've looked at this kind of thing
myself, looking at arrival rates and variability. To have 99% of
patients seen by a doctor within 1 hour takes about two and a half times
as many doctors as to see 50% within an hour (if you see your patients
within an hour and have point of care testing for the bloods you need,
an efficient x-ray system and ready access to beds, the 4 hour target
should be fairly easy). Obviously if you've got a large and predictable
seasonal variation, you need to staff for that. The issue is not that
the target is too high, but that moving from 95% to 98% will need
additional resources. I'm not sure that it is impossible to give
appointments for some of your patients or to make your triage system
more active in referring patients to other health care providers at
times of high demand in order to smooth things out a bit (don't do it at
times of low demand unless it is easy for you to change your staffing
levels)
Matt Dunn
Warwick
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