The way we see it, the time of day pretty much does determine the workload.
Put it this way, our attendance rates between 5pm and 9pm are pretty similar
to our attendance rates between 1pm and 5pm. And with those numbers, you're
bound to have the usual mix of sick medical/trauma/paeds/complex minors, so
we figure you may as well keep a consultant resident up until 10pm. Put
another way, we find we're kept busy, although admittedly not every case is
a crashing "let's-call-the-consultant-from-home" sort of case. Nevertheless,
having consultant input into the more moderately complex cases greatly
improves quality and certainly improves training. Horses for courses I
suspect.
AF
----- Original Message -----
From: "Dunn Matthew Dr. (RJC) A & E - SwarkHosp-TR"
<[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, October 03, 2005 9:00 AM
Subject: Re: A&E On - call Rota
>> Surely it's about time our specialty provided decent levels
>> of internal
>> cover, and by that I mean resident shop-floor cover by day
>> and increasingly
>> at evenings and part-weekends, with dedicated single-unit
>> cover at night,
>> just as most other acute specialities do?
>
>
> Maybe in London. In Warwickshire, many acute specialities cross cover
> across
> several sites.
>
> Not so sure about the advantages of consultants in the department in the
> evenings and at weekends as a priority. The way we work it is consultants
> on
> call from home, come in according to how sick the patient is rather than
> according to what time of day or day of the week it is. We have a fairly
> even spread of sick patients across the 24 hour period. Means we can cover
> a
> population of 270,000 with 4 consultants; all sick patients get seen by an
> emergency medicine consultant within a few minutes of coming through the
> door (in theory: some particularly expected medical slip through the net);
> EM consultants concentrate their clinical workload on dealing with sick
> patients rather than spending a high proportion of it dealing with minors;
> consultants don't expect to get through their night on call without
> getting
> out of bed, but don't spend a high proportion of their weekends on call
> sitting in the department.
> Use of orthopods wouldn't help particularly- most sick patients are
> medical.
> Big (or even moderate) increase in A and E consultants might have
> problems-
> I am concerned at the level of ongoing experience that consultants will
> have
> if their is more than one consultant per 50,000 population (and an bit
> concerned at the level with more than one per 100,000).
> Another way of providing cross cover would be to look at what we're
> actually
> seeing. For serious trauma (which is increasingly uncommon), you need the
> surgical/ ortho consultant in anyway, so they could come in from the
> start.
> May actually speed up getting the patient to theatre. Fits with the
> general
> consensus that in trauma it's how fast you get the patient out of the ER
> and
> into the theatre that matters more than what you do in the ER.
>
> For medical cases (where the evidence is that it's what you do in the ER
> that matters- as you'd expect: you can stabilise a medical case but not a
> trauma case in the ER), cross cover for critically ill patients wherever
> they are in the hospital between acute medicine, emergency medicine, ITU
> etc. Means a patient gets treated according to what they need, not
> according
> to where in the hospital they are. Also means you can have a smaller rota
> of
> consultants for critically ill patients (one rota rather than three), so
> don't have the issues with lack of experience.
>
> Matt Dunn
> Warwick
>
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