As an ex Preston A&E SpR I can vouch for this!
PAC
Dr Peter A Cutting
Consultant in Emergency Medicine
Leeds General Infirmary
Tel 0113 3926470
Fax 0113 3922810
>>> [log in to unmask] 13:58:45 07/01/2005 >>>
Both Preston & Chorley have successful OOH schemes, but they are run
very differently. Preston's OOH centre is 50 yards from the A&E
Department. Nurses are used to triage patients. Patients are moved
between the two, so an earache at A&E will be directed to OOH and an
MI
in OOH will go through to A&E. For some peculiar reason GP's can't get
x-rays but what we do is ask the A&E SHO to sign the form. The system
works well even though both sides occasionally moan about how the
other
isn't working hard enough.
At Chorley the OOH centre is a couple of miles from the A&E so there
isn't the same free exchange. Chorley doesn't employ nurses and so a
doctor does the triage. This can mean that a phone conversation can
solve the problem, but it also means that we can have seriously ill
people needing resuscitation before transfer. This actually means that
the Chorley doctors do have more resuscitation training.
If you are faced with setting up a system as an A&E consultant then I
would use the Preston model as errors are easier to sort out. The OOH
side really does need at least one GP on duty, as A&E doctors just
don't
have enough family medicine and community medicine under their belt.
We
tend to rattle through patients at ten minutes each at the centre,
but
visits take half an hour on average. Visits are mainly the elderly,
and
often the dying. Opiate access for syringe drivers is a must.
What else can I tell you?
Vic Calland
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of
[log in to unmask]
Sent: 05 January 2005 22:27
To: [log in to unmask]
Subject: streaming
Does anyone have a good streaming tool they use to feed patients into
a
primary care stream?
My local PCT has at long last discovered that they are paying a shed
load of money for an OOH service that is diverting most of their work
to
the A&E.
Since the whole thing has gone belly up and is now in recievership,
they
are coming to me to help them out.
I will try and develop an integrated unit with them but I want to make
sure there is a benefit for the A&E department as well as the
patients.
I keep getting the "triage is evil" phrase from the residual Emergency
Services Collaborative, so what do you call a streaming system that
pushes the primary care stream to the primary care physician so as to
get them off your back?
I know some of you out there have got this up and running, I met some
of
you at the various ESC meets but have had great difficulty with my
local
GP's so far. They are keen that we stream them all to our ENP's or the
department allowing them to earn their cash asleep.
Also this "don't triage" mantra is a serious obstacle round here.
Andy V
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