Heard a doctor's representative on the radio yesterday saying there was no reason why a senior A&E doctor couldn't be at the front door 24 hours a day directing people away to their GP with stuff that didn't need treating in A&E.
Seemed to miss the point of why I trained and why I'm supposed to be most useful to the department. Unfortunately our ability as consultants to quickly assess non emergencies and NOT see them is becoming more valuable to the system than our ability TO see emergency patients and treat them expertly.
Simon
"Hospitals with overcrowded Emergency Departments are overcrowded hospitals that have chosen to manifest the overcrowding in a single location"
Full Capacity protocol: an end to double standards in acute hospital care provision Emerg Med J 2011;28:547-549
-----Original Message-----
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Rowley
Sent: 07 June 2013 09:16
To: [log in to unmask]
Subject: Re: In case you missed the Radio 4 Program
Hmm. If the people who write 111 can't get it right, how can we expect Joe
Public to? We have to remind ourselves what is written above the door.
Emergency department. Our job surely, is simple.
Let's change the name above the door. Let's call ourselves - Boots the
chemist. A person comes in and says, "Hello, I'd like a loaf of bread."
Now what is our response? "Ooh, that will take about 4 hours to prepare,
rise and bake. Take a seat, and we'll give you it when we have sourced all
the ingredients, the breadmaker and it is done." Or, "I think you need
Greggs, they are next door."
We are very much acting like the first crazy response. Whatever people turn
up with WE FEEL THE NEED TO TREAT IT. We need to do enough to decide if it
is an emergency and then behave accordingly.
There are only three places you can go once you have arrived in an ED - in,
out or up. If the patient isn't dead and can't go home they get admitted.
Otherwise, if it is in the reasonable skillset treat, if not, they go. Some
work needs to be done to establish it isn't our remit in some patients, but
you get the drift. We must rid ourselves of the mindset that because they
chose to come to us the onus suddenly is on us to provide whatever is
wanted. However, everyone including MPs, the DoH, our Trusts and Monitor
must understand this so that we do not get criticised for apparently not
treating people like the one who turned up recently complaining that she
wanted treatment because she had been smelling toast for a month.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Boyle
Sent: 06 June 2013 14:04
To: [log in to unmask]
Subject: Re: In case you missed the Radio 4 Program
What is our message? I think we all know what the 'symptoms are, can
probably guess at the causes but I haven't heard a convincing treatment
package proposed. I think the GPs are wresting the initiative away from us
on this. The politicians must be glad for summer and hope that this problem
goes away for at least six months
Symptoms
Increasing input (but not by very much) Full departments offering patchy
chaotic care and poor performance against the 4 hour target. Poor
recruitment at HST and Consultant level.
Causes
Decreased bed capacity within hospitals, decreased social care beds for the
very elderly, increasingly complex discharge paperwork. Long waits to
outpatient clinics for sub acute emergencies. Fragmented and inconsistent
OOH care that confuses the public. Risk averse triage algorithms such as
111.
Relatively unattractive rotas and renumeration compared to just about any
other doctor in training.
Treatment package
(Other than a stiff double) System wide reform for all unscheduled care.
Simplify choice, and improve equity of access to GPs across the clock.
Invest in social care beds. Offer retention bonuses to middle grade / HST
doctors. Push for 50% of FY2s / GP VTS doctors to undergo a ED post.
Facilitate transfer of surgeons and physicians at ST3 level across into HST
if they have a change of heart.
Ah well, nice thinking about it
Adrian
On Sun, 2 Jun 2013 14:29:17 +0000
Doc Holiday <[log in to unmask]> wrote:
> There are two aspects here:1. The state of EM & EDs in the NHS and
>associated problems2. The potentially negative effects EM work and of
>number 1 above on any one of us and/or colleagues Some of the
>contributors on this thread have lamented point 1; others have noticed
>that point 2 applies to themselves; yet others appreciate BOTH aspects
>in the view they expressed.
> NOT everyone has a number 2 issue. Some are merely worried about
>number 1.
> Your solution is for number 2 only - part-timig is completely "right"
>if it's what you feel is right for yourself. It IS professionally
>responsibe. But in itself, even if also chosen by many others, will
>likely not resolve point 1 above, which is, I think, what the Radio
>4 Programme was about.
>
> Date: Sun, 2 Jun 2013 14:45:48 +0100
>From: [log in to unmask]
> Subject: Re: In case you missed the Radio 4 Program
> To: [log in to unmask]
>
>
>
>
>
>
> Have you guys and gals checked your collective BP recently?
>
>
>
> Mine's fine.
>
> Here's why.
>
>
>
> I can't fix any of the problems you raise.
>
> I'm not sure anyone can - we are no longer prosperous enough to
> afford the solutions.
>
>
>
> I can manage the mismatch between my personal resources and
> the demands placed on them.
>
> I've gone part-time.
>
> Call it running away if you like. Some of my colleagues do, sotto
> voce.
>
> I prefer to think of it as accepting limits - my own and the system
> - and working to them.
>
> It's like a strike really, but I still get paid something and it's
> more professionally responsible, just.
>
>
>
> Now when I go to work, I can deliver my slim-line job as
>effectively
> as the system will allow me to.
>
> I'm not perfect. Nor are you.
>
> When things go wrong, I still reflect honestly on my own
> imperfections and the systemic failures, aired so eloquently on the
> list.
>
> Those twin banana skins will always be there for me and my
>patients.
>
> Assiduous attention to CPD minimizes risk from the former, and
> alerting safety managers when appropriate is all I can do to
>address
> the latter.
>
> But at least now I am not impaired by fatigue or stress and I don't
> go home and metaphorically beat up the wife and kids any more.
>
> As a small cog, that's all I can do.
>
>
>
> This winter nearly finished me off, professionally speaking.
>
> What about you?
>
> And I live and work in an easier place to function than you do,
> probably.
>
> I am additionally fortunate in supportive and sympathetic
> colleagues.
>
>
>
> So, I am cash-poorer, but feel enriched.
>
> I'm genuinely sorry if you really can't afford the option.
>
> Some nurses I work with really can't afford to go part-time.
> And yet they have, or left. Why?
>
> Perhaps they can't afford not to.
>
> Perhaps potential ED trainees think the same.
>
> Perhaps they're brighter than we give them credit for.
>
> Perhaps they're brighter than me. After all, it took me years to
> work it out.
>
>
>
> Fix what you can fix and look after your BP.
>
>
>
> Goat
>
------------------------------
This e-mail and any files that accompany it are intended only for the appropriate use of the addressee/s, and may contain information that is privileged, confidential or exempt from disclosure. If the reader is not an intended recipient, any disclosure, distribution or any action taken or omitted to be taken in reliance on it, is prohibited and may be unlawful.
If you have received this e-mail in error, please delete it from your system and notify the sender immediately. Any views or opinions presented do not necessarily represent those of the Trust. Any unauthorised disclosure of the information contained in this e-mail is strictly prohibited, as is use or application of its contents other than for its intended purpose . Neither Rotherham NHS Foundation Trust nor the sender accepts responsibility for viruses. It is your responsibility to scan the email and any attachments. ------------------------------
|
