>No, you misunderstand me I think, Doc, I meant fiddling happens in order to
>comply with the targets. In other words, the nurses often move a patient
>into the CDU at 3 hours 59 minutes, not for any genuine CDU-type
indication, but merely because there have been delays in assessment,
investigation, referral or admission to a bed. From a purist's perspective,
this is incorrect usage of a CDU, and could be viewed as "cheating" the
system in order to comply with targets.
--> Of course you're right - it IS incorrect usage of CDU. Also right that
this particular move won't cause patients compromise. The problem arises
when the "cheat" is done by staff who are not as careful about where they
send patients or by staff who do not have an empty bed in a CDU (or a CDU at
all), as in the examples I gave and others. Cheats, of course are happening
all the time, with some patients kept outside in ambulances and others
discharged from a ward bed to "discharge lounges", where they can sit in a
waiting room environment for a few hours, so that someone else can have
their bed.
>But we (understandably) failed to convince our non-ED colleagues about
>these issues, and that's where the targets have been stunningly successful.
>So yes, we didn't need incentives, of course we didn't, but just about
>everyone else in the "emergency care system" did!
--> Our "non-ED colleagues" have similar ethics to ours and similar
training. They now also suffer from stress and are also having to "cheat".
Where do they cheat the patients to when they have to get them out earlier
due to pressure? The only type of person who is exposed to targets, but NOT
to ethics training nor to an understanding of clinical needs and outcomes
are certain types of managers.
>I'm not convinced, Doc, that I'm more stressed by life after the targets
>than I was with life before the targets. It's a different sort of stress,
>but I wouldn't go back to ED life before 2003 if you paid me...
--> There is no offer for you to time-travel back. That would take away all
the funding and all other "good bits". I am only hoping to speed up the time
when the targets are CLINICAL and not on a clock. I believe medical staff
can make these work with the extra funding. It's great that you are not
stressed and I'm happy that all the "cheating" which happens at your place
actually improves patient care. And, I believe there are a few others around
who are happy with the targets. Lots who are not.
But never mind. No use going about in circles. I don't expect we have more
than a few months left anyway, then it's election time.
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