To add to what Rowley has said, from an ambulance perspective, we consider
it really important not to transport patients to hospital who are not
going to be admitted, within the limitations of patient choice (if a
patient wants to go to hospital, we will always honour that request).

Since the introduction of antibiotics, oral rehydration solution,
ondansetron, anti-inflammatories, codeine and diazepam, we have targeted
common problems that are not routinely admitted and treat in the home -
back pain, chest infection, D&V.   Risk is reduced with an aggressive
system of revisiting patients.

We are now transporting fewer patients to hospital than in 1999, despite
an increase in calls and activity.

What is interesting for us is that hospitals in our catchment area are
reporting good ambulance turn-around, especially Danny's, which we use a
surrogate marker for how well the Emergency Department is coping.
Hospitals outside our primary catchment area, where our patients are in a
minority, have longer turn-around times.

As Rowley says, it is about a whole systems approach and viewing this a
local health economy target, not an Emergency Department target.

Anton
Staffs

Rowley Cottingham said:
> I think there are a few tales like that from departments for whom the
> target wasn't a particular issue at first - they cruised and wondered
> what the fuss was about until the screws got turned. The 97% one seems
> to have been the big problem for many of the high performers. I remember
> at the beginning (like Katherine) finding it all a bit baffling and
> casting around for ideas from others. However, it rapidly became clear
> that the ED team should not be the motivators - you end up looking as
> though you are trying to interest everyone else in "your" target. From
> the beginning we talked of a local health economy target and tried to
> sell the benefits that fell out (which often weren't immediately
> apparent) to others. With hindsight I recognise that there are two
> important system improvements that must happen; more efficient use of
> medical beds and preventing patients being admitted for investigation
> that can be done in the ED and CDU. These both free up beds, although as
> I said last week maybe not enough. I think we could do a lot more
> investigations in this ultra-short stay environment but imaging needs
> significant investment to make this happen.
>
> Don't cane yourself for not being the motivator - as you have found, all
> that happens is they see self-interest. Ask not what you can do for the
> 4 hour target but what the PCT and Trust can do, to bowdlerise a great
> quotation.
>
> Best wishes
>
>
> Rowley.
>
>
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of
> [log in to unmask]
> Sent: 25 January 2005 12:23
> To: [log in to unmask]
> Subject: Emergency Care Leads
>
>
> having been the lead for my trust, my arm was twisted until I said yes,
> it has been a completely soul destroying year. My trust started at 97%
> but it had been 100% the previous year, I predicted we would get the
> first two targets which we did by working the A&E to death, See and
> Treat, ENP's and anything else we could think of.
>
> Unfortunately the PCT and trust did naff all themselves. There was no
> financial support and it was only when we failed to achieve the third
> target that they started to notice. The plot from our start was
> consistently down and we crossed the upgoing target line just before the
> third measuring period.
>
> The immediate response from the ESC group lead was to concentrate on
> telling us we were at fault in A&E and let the rest ride. The PCT has
> still not accepted that they might somehow be at fault. They see it as a
> trust target. The trust now see it as a whole system target and last
> week was the first time they actually decided something must be done
> about pressuring the in hospital teams into looking at some of their
> archaic practices. We got a DVT specialist nurse in post last week but
> there is still no buyin from half the hospital.
>
> Some of this must be down to me not being a terribly efficient motivator
> but 4 presentations to the consultant body with the response of "what do
> we need to know about A&E targets for" and a refusal of anyone from the
> PCT to have anything to do with the ESC until there was some money to
> dish out from our targets, and then running for the hills when we asked
> for action dragged me down.
>
> We are now running at a consistent 93% due to waits for beds and Access
> to specialist opinion. When they fill my See and Treat area (used to be
> my obs ward until it was closed to save money) with beds like they did
> last night and over the weekend, then I get an immediate increase in
> group 1 breaches that normally run at 0.5% to 1%. Last night it went to
> 9%.
>
> So I have had a wonderful time as Lead
>
>
>
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