A question all of us are being asked or will be asked - and something
that may well become part of revalidation. I would break down the
Consultant role into its key componants and look for metrics in each:
Clinical Teacher - number of sessions, quality of learner feedback.
Clinical Manager - turnround times for complaints, 4 hr target
performance when leading the floor
Expert Clinician - admission rates and returns, patient feedback,
?simulation testing results
Clinical Leader - 360 feedback
This approach has the advantage of emphasising the range of activity
that goes into the Consultant role.
Tim. Coats.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Dunn Matthew Dr. (RJC)
A & E - SwarkHosp-TR
Sent: 18 May 2009 09:38
To: [log in to unmask]
Subject: Re: League Tables for Emergency Medicine Consultants
> Sorry, I had my tongue in my cheek Matt.
>
I thought you might. However, it's actually not a bad one. Ray McGlone
mentioned looking at the number of patients seen by each doctor. The
trouble with this is that it encourages cherry picking (you can split up
patients into ambulance patients, resus and minors, but it still
encourages cherry picking from within each group). More of an issue
though is that you'll perform "better" on this by seeing patients rather
than by keeping an eye on what's going on in the department. The
advantage of the 4 hour wait instead of this is that it shows who is
performing best as a team leader. Sometimes that involves seeing a lot
of the quick patients (either trolley or minors yourself); sometimes it
involves seeing the most complex patients yourself; sometimes it
involves taking on all the procedures; sometimes it involves sitting in
triage; sometimes it involves keeping an eye on the whole department,
giving a bit of advice on every patient by not being the main doctor to
see any one of them. The nice thing about it is that it's a measure of
outcome rather than process (so harder to game on) and that it picks up
those who are best at performing at consultant level rather than at SHO
level. Couple it to measures of quality of care possibly including
mortality, unplanned returns, number of x-rays and investigations done
(with high numbers being a bad thing), referral rates etc. and you've
got a nice measure.
Matt Dunn
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