This old chestnut is rearing its head for us, particularly as, for us, there are more breaches of the four hour standard happening at night.
There is pressure being put on us to be called back when the wait to see an ED clinician gets to 90mins...regardless of acuity. We already have an escalation policy that encourages the nurse in charge to call the consultants back should certain categories of patients be waiting certain lengths of time OR if they feel the department is 'unsafe'.
We have pointed out CEM guidelines:
When on-call, an EM consultant should not be recalled to hospital solely to deal with a build up of less serious cases, because of excessive waiting times for first assessment or because of potential breaches in the DH operational emergency access standard ("4 hour target").
Each ED and hospital as a whole should be staffed and resourced to a sufficient level to manage what are predictable peaks in workload, 24 hours a day, seven days a week. Where this has not been adequately addressed by a Trust, the on-call EM consultant must not be expected to make up for any deficit in staffing or other resource.
The decision whether to return to the ED or not, is one of a clinical, professional nature and should be a personal decision, made by the on-call EM consultant, in full possession of all relevant contemporaneous information. It is not appropriate for a manager (clinical or non-clinical) nor for a clinician in another specialty, to make this decision.
...but we have been told in no uncertain terms what are thought of these by our management team.
Are we out of step in standing by the College guidance, are others in this position coming in to clear waits, OR are there colleagues standing up to this and will the College back us should we refuse to comply?
Your advice and observations would be appreciated.
Simon
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