worth bearing in mind as well that I was not suggesting departments close; just that less of them are fully functioning ED's with an aspiration of 24/7 consultant presence; I think I talked about 'sensible re-configuration' which might involve clinicians other than consultant staff leading some units: colleagues at HEFT (one of the busier trusts in the conurbation) advise me that non-medical staff now manage 53% of workload in ED - more widesrepad use of this sort of expertise is what I was considering
regards
jimB
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From: Accident and Emergency Academic List [[log in to unmask]] on behalf of ACAD-AE-MED automatic digest system [[log in to unmask]]
Sent: 22 October 2013 00:05
To: [log in to unmask]
Subject: ACAD-AE-MED Digest - 20 Oct 2013 to 21 Oct 2013 (#2013-61)
There is 1 message totaling 416 lines in this issue.
Topics of the day:
1. ACAD-AE-MED Digest - 17 Oct 2013 to 18 Oct 2013 (#2013-58)
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Date: Mon, 21 Oct 2013 13:48:56 +0100
From: Prescott Mark <[log in to unmask]>
Subject: Re: ACAD-AE-MED Digest - 17 Oct 2013 to 18 Oct 2013 (#2013-58)
Looking at the volume of ED traffic in the conurbation that Jim B works
in, I am not sure if many departments could sensibly take on enough
numbers to close enough departments to free up staff.
Birmingham and surrounding urban environs patient demands are
challenging every department.
Spreading the consultant numbers available across 24hrs in fewer
departments would be difficult because in the wee hours there will still
not be many consultants to go around a whole department that has grown
up to a super-sized factory.
In my opinion application of supermarket macroeconomics has limitations
in EM - not least because few if any non-MTC departments make enough
profit to buy in all the staff they need
Mark
________________________________
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Matthew Dunn
Sent: 20 October 2013 09:11
To: [log in to unmask]
Subject: Re: ACAD-AE-MED Digest - 17 Oct 2013 to 18 Oct 2013 (#2013-58)
I'm not sure economies if scale really come into it. Once you get
departments serving a population of over 200,000 or so you start to run
into diseconomies of scale. It is interesting to note that the UK
already has more centralised ED services than other countries with
developed EM. Larger departments will make it easier to have 24/7
consultant presence but will also mean that a single consultant cannot
keep an eye on the whole department. Interestingly there was a paper
from Hong Kong some years back where their solution to long waits was
effectively to split their single large department into two departments
on the same site.
Matt
On 19 Oct 2013, at 18:15, "Bethel, Jim" <[log in to unmask]> wrote:
might economies of scale need to be considered as well? -
working in a conurbation that has 9 ED's within a 10 mile radius of the
centre I wonder if this is sustainable in terms of providing the sort of
senior level cover we are talking of?I doubt that this situation is
unique to the conurbation I work in. Only one of these 9 ED's is an MTC
and of the others some struggle a great deal to recruit adequate senior
medical cover to operate effectively - surely hanging on to this
antiquated model of working is not only financially unsustainable now
but unsustainable in terms of the standards for service provision
required these days
Sensible and reasoned reconfiguration of emergency services
requires that this should be done not for political or financial
expedience but in the best ineterests of the patient - who still expect
(and believe) that all ED's are created equal
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End of ACAD-AE-MED Digest - 20 Oct 2013 to 21 Oct 2013 (#2013-61)
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