The best answer is 'not as many as the politicians and 
senior managers think. We looked at this a couple of years 
ago. The only group that we were seeing that you could 
really describe as a failure of community services were 
urinary catheter problems and imminently dying, but 
expected, patients. I'm going to go lower and say 10%

Adrian

On Tue, 11 Jun 2013 19:56:09 +0100
  RC BAILEY <[log in to unmask]> wrote:
> not many at present because of the lack of appropriate, 
>easily accessible community care - if it were available 
>I'd guess around 1/3  
> 
> 
> ________________________________
> From: Coats Tim - Professor of Emergency Medicine 
><[log in to unmask]>
> To: [log in to unmask] 
> Sent: Tuesday, 11 June 2013, 17:40
> Subject: Re: Attendances and GPs
>  
> 
> 
> 
> OK. My next question to the list: 
> Of all the sick elderly patients who are awaiting 
>hospital admission in your ED, what proportion do you 
>think could be managed outside hospital given a realistic 
>(in current economic climate) amount of investment in 
>community care? 
>   
> Again this will vary, but my local experience is that 
>they mostly need ‘hospital’ type interventions and would 
>not be suitable for community care. I think that we can 
>assume that relative’s expectations of higher level care 
>for elderly people coming to the end of their life will 
>not go away. What is your guess on the percentage of 
>patients that could be managed at home from your ED if 
>some resources are moved from hospital to the community? 
>   
> Tim. 
> ------------------------------------ 
> Prof. Timothy Coats 
> Professor of Emergency Medicine, 
> University of Leicester, UK 
> 0116 252 3263   
> 
> ________________________________
>  
>From:Accident and Emergency Academic List 
>[mailto:[log in to unmask]] On Behalf Of James 
>Connolly
> Sent: 10 June 2013 21:02
> To: [log in to unmask]
> Subject: Re: Attendances and GPs  
>   
> Tim  
>    
> I posted on this last week  
>    
> It is exactly this  - a lot of complex multi co 
>morbidity elderly patients ( or even younger 
>chronologically with lots of co morbidity)  
> Like you I think the message of lazy GPs is a smoke 
>screen  - few of these patients are suitable for 
>community care and more importantly their and their 
>families expectation of care is increasing  - I spend 
>large amounts of my shift with desperately ill elderly 
>patients , giving them the best work up I can and 
> planning their appropriate level of care, taking time 
>with the family / ITU discussions etc..  
>    
> I like you am beginning to believe that no amount of 
>tweaking the system can decrease the input of this 
>population in to the department  
>    
> Unblocking the other end so there are discharges and so 
>capacity may help somewhat  
>    
> I find the  concept of the solution being to reduce 
>hospital beds a little optimistic!!  
>    
> jim  
>    
>   
> James Connolly
> [log in to unmask]  
>   
> -----Original Message-----
>From: Coats Tim - Professor of Emergency Medicine 
><[log in to unmask]>
> To: ACAD-AE-MED <[log in to unmask]>
> Sent: Mon, 10 Jun 2013 9:16
> Subject: Attendances and GPs 
> Can I use the list to cross-check what I am seeing.  
>    
> The current government emphasis on ‘inappropriate 
>attenders’ due to ‘lazy GPs’ doesn’t really fit with what 
>I am seeing in my own ED – where we seem to be 
>overcrowded with sick elderly patients who need a level 
>of care that cannot be provided in the community, but 
>they remain in the ED as there are no beds for them to go 
>to. Patients with minor conditions who could have gone to 
>their GP are certainly still attending the ED – but if 
>they were removed I don’t think that it would really 
>create much improvement in the current pressure (as most 
>are either diverted or seen rapidly by nurse 
>practitioners).  
>    
> If I am experiencing something different from the 
>national picture then we may be right to emphasise 
>failings in primary care. If the underlying cause of the 
>current crisis is (as it seems from my perspective) the 
>initial explosion of the demographic time bomb of a 
>rapidly aging population – then we are talking about the 
>wrong issue. If we are talking about the wrong issue we 
>are playing into the hands of the politicians who would 
>like an easy target (‘lazy GPs’) rather than tackle the 
>politically very difficult, and potentially expensive, 
>issues that surround how we look after old people, 
>relative’s expectation of level of treatment, management 
>of dying, end of life planning, resourcing the hospital 
>care for the current rapid increase in our elderly 
>population, and resourcing the social care required.  
>    
> I would be very interested in the list’s experience – is 
>it really patients who cannot access GPs that are causing 
>a crisis in your ED?  
>    
> Tim.  
> ------------------------------------  
> Prof. Timothy Coats  
> Professor of Emergency Medicine,  
> University of Leicester, UK  
> 0116 252 3263    
> 
> ________________________________
>  
>From:Accident and Emergency Academic List 
>[mailto:[log in to unmask]] On Behalf Of Jel 
>Coward
> Sent: 06 June 2013 17:43
> To: mailto:[log in to unmask]
> Subject:    
>    
> On 6 June 2013 09:22, PHILLIP OCONNOR 
><[log in to unmask]> wrote:  
> Am I the only dissenter?   
>>    
>>Positively I agree with GPs doing a year of ED after 
>>their core training and immediately before GP land.  
>>     
>     
>     
> That would be good.  Similarly forcing ED career track 
>trainees to do a year of GP.  Do you agree?   
>     
>  or bill the GPs for their non-urgent patients.     
>     
> Get lost.   So wonderful for us to characterise 
>colleagues as the bad guys - helps our egos, but not much 
>else.   
> There is a stack of stuff that GPs see that could 
>appropriately be seen in A+E - should they bill you?   
> There is a stack of stuff that GPs deal with that are 
>bounces back from inadequate hospital care -  should they 
>bill you?   
> Picking on each other goes nowhere.   
>     
>     
> To your second point.......I agree that _forcing_ folks 
>to work in places they don't want to be is 
>counter-productive.   
> Cheers :)   
> Jel   
> 
> 
>     
>  If I need a plumber at 1.00 am, he will charge me £120 
> call out fee, therefore that blocked sink can wait...   
>>    
>>Phil   
>>    
>>.       
> 
> 
> 
> -- 
> Jel Coward
> 
> Some Open-Source and Creative 
> Commons interests.....
> The CARE Course http://www.thecarecourse.ca/
> Wilderness Medicine Twitter account
> WEMSI-International http://wemsi-international.org/
> OSCAR open-source EMR http://oscarcanada.org/     
>   
> 
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