Isn't it interesting to hear what motivated us to get involved in the 
specialty. I was attracted by the variety of the work and particularly enjoy 
being involved in a number of cases at once. What I hated about ward work 
was the drudge day after day seeing the same patients not making much 
progress, tweaking their meds and then coming back to see if they were any 
better - balls aching! What worries me now is that the specialty could be 
heading that way by taking over responsibility for the first 48 hours via 
MAUs etc which one could imagine morphing into longer periods with time!
BW
Sue

----- Original Message ----- 
From: "Adrian Fogarty" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, September 20, 2006 12:08 PM
Subject: Re: Models of undifferentiated medical care


> It's funny you should say that Sue. I must be one of those men. I find it 
> incredibly hard to multitask, but didn't realise there was a gender bias! 
> I thought it was just part of my "borderline Asperger trait" which is no 
> doubt gender biased anyway. I'm the sort of person who stops my car to 
> take a phone call, and that was before they introduced a law about it.
>
> Coming back to ED, we run a similar system, though thankfully the 
> registrars run it, as the consultants oversee the whole unit, including 
> majors/minors/resus/paeds/CDU, so can't really stay pitched in majors 
> doing "pitstops" all night, or whatever you call them. Yes, the consultant 
> can get pulled from pillar to post, but thankfully only has to deal with 
> one problem at a time, before moving on to the next.
>
> One of the reasons I was attracted to ED in the first place was that I 
> detested ward work. I hated the way you had to remember what was going on 
> with some 20 or 30 patients at a time. I always felt more comfortable 
> dealing with one problem at a time, no matter how complex that problem 
> was, to the exclusion of all else until that problem was sorted out. And 
> ED seemed to provide that sort of environment, at least it did in the 
> early days. I work the same way now in my management sessions at work, or 
> in my medicolegal role outside the NHS.
>
> Unfortunately now there is an increasing trend for someone to "run the 
> whole unit" whether that is the nurse in charge or the "pitstop" doctor, 
> or more usually both. And keeping up with 30 ED patients is a lot more 
> challenging than keeping up with 30 ward patients.
>
> So spare a thought for us men with "one track minds". We're not completely 
> useless in an ED. We just have to be told which problem you want sorted 
> out first!
>
> Regards
>
> AF
>
>
> ----- Original Message ----- 
> From: "Suzanne Mason" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Wednesday, September 20, 2006 10:01 AM
> Subject: Re: Models of undifferentiated medical care
>
>> Hi Paul
>> Hope you are well? In Sheffield we tried triaging via consultant at the 
>> fromt door to specialties, but found that there were very few patients 
>> who did not need something doing straight away. Many staff did not feel 
>> confident just shipping straight out to other departments. We compromised 
>> and have a system that I believe lots of Eds use where consultants triage 
>> and order obs, tests and direct patients to specialties, but they are all 
>> seen by another medic and nurse first for work up. If it's a clear 
>> admission, then they need minimal work up, but we felt from a risk 
>> management perspective that it was worthwhile. We call our system 
>> PITSTOP. It has met with some resistance in the ED and some consultants 
>> refuse to do it (my theory is that they are men who cannot cope with 
>> multi-tasking!!). I'd be happy to give you more info over the phone, or 
>> if you fancy a visit to see us, then please do.
>> Best Wishes
>> Sue Mason
>>
>> ----- Original Message ----- 
>> From: "Redman Paul (Frimley Park Hospital NHS Trust)" 
>> <[log in to unmask]>
>> To: <[log in to unmask]>
>> Sent: Tuesday, September 19, 2006 8:03 PM
>> Subject: Models of undifferentiated medical care
>>
>>> 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
>>>
>