> There has been no change to the Emergency Medicine Tariffs.
> I'm still trying to find out the exact triggers for the High
> Cost Attendance. Anyone know?
You understand that this is classified information and I'm probably in
breach of the Official Secrets Act by telling you, but I managed to find out
a bit.
High cost: Cross match, X-ray, CT, Ultrasound, Histology.
Standard cost: Any other investigation
Minor injuries: No investigation.
I don't know what emergency histology is- presumably frozen section.
I don't know if cross match includes group and save.
Also, I don't know whether any procedures get funded separately e.g. if a
patient comes in with a cut finger and I do a digital nerve repair, is this
just a minor.
I don't know what "ultrasound" means- if I do the repair under an ultrasound
guided nerve block, does this change it to high cost? Also, if I get a
Colles' fracture in, that's high cost because I tend to x-ray (with
apologies to those wanting to point out that Colles described the clinical,
not radiological appearance), but if I manipulate it, do we get extra? If an
arthropod manips it in A and E, do we get extra? Presumably if an orthopod
manips it in theatre we get extra. What if I manip it in theatre?
If anyone knows more, I'd be very interested to hear.
> Besides, much of what you've listed below forms part of
> other's budgets, as
> I presume the A&E payments go purely to A&E.
The money doesn't go to the department, it goes to the hospital. Everyone
I've spoken to about it who knows a bit (which is admittedly a remarkably
small sample) reckons that acute admissions and EDs will be effectively
subsidising the rest of the hospital in many hospitals.
Matt Dunn
Warwick
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