At Addenbrooke's, we now have an EAU where every unscheduled attendee is
seen in the ED by a combined team of junior doctors from medicine, surgery,
orth, and emergency medicine. We try to get GP referrals seen by the
appropriate team but otherwise we share the workload. The ED consultant has
overall responsibility for the ED. The ED is backed up by 4 short stay wards
which are co-located (CDU run by us; Med SSW; Surg SSW; and COU - children
sobs unit).
The key is NOT to bypass the ED but to work everyone up in the 4 hours (yes
including medical admissions)
We have eliminated serial clerking by getting the first doctor to clerk
including drug chart etc. That means each patient gets an initial assessment
and then senior review; rather than ED junior > ED senior > med junior > med
senior etc.
Working quite well so far (has only been fully functional for 3 months)
Copy of assessment process attached
Regards
Paul
Dr Paul Atkinson MRCP FCEM
Consultant in Emergency Medicine
Box 87, Addenbrooke's Hospital
Cambridge University Hospitals NHS Foundation Trust
Cambridge CB2 2QQ
Tel. 01223 217792
www.emergencyultrasound.org.uk
-----Original Message-----
From: Alan Montague [mailto:[log in to unmask]]
Sent: 19 September 2006 22:20
To: [log in to unmask]
Subject: Re: Models of undifferentiated medical care
"....transferred to the specialty ward...directly"
When does such a ward ever have any useful number of
empty beds? Paul, I am delighted for you that you
find yourself contemplating this circumstance in the
2006 NHS.
Of course things were different in my day!
Good wishes,
Alan
--- "Redman Paul (Frimley Park Hospital NHS Trust)"
<[log in to unmask]> wrote:
> Does anyone work in an environment where the ED is
> the 'front
> door' to the hospital and patients get triaged to
> specialities directly (possibly by ED consultants)?
>
> So as the patient arrives, if they are critically
> ill they
> get moved to resus, if stable and either have no
> formal
> diagnosis or are potentially dischargeable following
> a period
> of observation then they are moved to to majors /
> trollies
> for ED further work up. But if they are stable with
> an
> obvious medical or surgical problem, then they get
> transferred to the speciality ward (MAU / SAU /
> TAU)directly,
> bypassing the ED, rather than being worked up and
> then 'referred'.
>
> Does anyone have the MAU / SAU under the 'umbrella'
> of the ED?
>
> We are looking at various versions of altering the
> way we
> stream patients and would be grateful if anyone has
> any
> experiences we could use.
>
> Please contact me off list if you feel it's
> appropriate.
>
> Paul Redman
> Frimley Park
>
>
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