Locally we appear to have convinced the Trust that Waiting Times in ED are
symptomatic of a system not necessarily an ED problem.
The Parable I give them regarding simply calling in the ED Consultant is as
follows.
If there is a Fire and staff press the Fire Alarm then they would expect
more than one Fireman to attend the scene. So if the situation is that bad
then I expect other specialties to respond as well from home, the on call
manager to be in ...... and more nursing staff to help keep up with me
regarding treatments. They seem to understand that.
Having said that we need to look after our staff as well by supporting them
otherwise we will lose even more.
Regarding nights you perhaps need to raise a question. What are the juniors
/ trainees in other specialties doing overnight. At FCEM recently I heard of
one O&G junior who had put up a camp bed in the Education Centre overnight
and another case recently where a surgical junior was found sleeping in a
Ward Bed. Overnight the staff in the hospital should be based where the
work is. The NHS can't afford to pay doctors to sleep on a full shift. They
are "taking the Michael" http://en.wikipedia.org/wiki/Taking_the_piss
Regards
Ray
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of McCormick Simon Dr,
Consultant, A&E
Sent: 11 November 2013 09:50
To: [log in to unmask]
Subject: Waits at night
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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