> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Matthew Dunn
> Sent: 07 June 2013 15:41
> To: [log in to unmask]
> Subject: Re: In case you missed the Radio 4 Program
>
>
> > arguably if you are going to put a 'Specialist' Doctor at
> the front
> > door of
> > A+E to do a job which a Band 5 Nurse can do if appropriately
> > supported (
> > triage + signposting)- it should be a GP ...
>
> I don't think it really is something a Band 5 nurse can do
> regardless of support. You need someone who can make a rapid
> assessment (otherwise you won't get through the patients),
> manage uncertainty (deciding which patients with normal/ ish
> observations and no definite diagnosis need a fuller
> assessment there and then; which can contact their GP next
> working day; and which don't need to see a doctor), and
> deciding on sensible risk taking.
> Tony Redmond published on it in the 1990s. He would send
> about a third of patients away from triage. That's probably
> way above what a Band 5 nurse could do.
Depends on whether you want to signpost or whether you want to be able to
turn people away ?
While 'Interventional Assessment' got a bad press because of the
perception of it being something which just costs money through 'unneeded'
( through the stereoretroscope) investigations
Nursing's biggest problem is itself and the fact that there is still a
faction ( often of traditionally trained ) of Nurses who want a nice
apparently low responsibility path ...
>
> Using a GP is one possibility. However it is worth noting
> that sensitivity of clinical examination by GPs for picking
> up serious disorders has been shown to be low in a number of
> studies (sensitivity of EPs may be similar, lower or higher,
> it just hasn't been studied as well).
Again this depends if you just want to signpost or whether you want to send
people away with a 'completed' episode ...
> This is not a problem
> in a population with a low prevalence as negative predictive
> value is OK, but patients attending EDs are more likely to be
> sicker. The other side of this is that specific parts of
> examination are probably less important in decision making at
> triage than physician gestalt. Physician gestalt learned in
> one setting may not translate to another. So the question
> there is whether patients coming to triage are similar to
> patients attending their GP. If they are, you might find that
> using a consultant EP would mean overtriage (i.e. not as many
> patients been sent away as could be). If they aren't, then
> using a GP might result in under triage (so some patients are
> sent away who shouldn't be). It is an interesting question
> and one that might warrant a good quality study.
>
> Matt Dunn
I'd agree with all of that.
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