At 09:16 AM 29/9/98 +0100, John wrote:
>One of the most effective ways I have seen of keeping patients with lower
>acuity problems out of emergency departments was in Australia. GPs are paid
>on a fee per item basis so it is in their interest to ensure they can see as
>many patients as possible and as often as possible.
John however did work in a department that actively triaged out of the
department to the local 24 hour medical clinic those patients who were
deemed to be suitable.
Patients also didn't turn up for such things as they knew they would be
a/triaged out
b/not seen for a long time and
c/a combination of the above
Many departments don't have this luxury(eg mine;please read the next with
imagined violins)and see them all regardless
Australian emergency physicians have a slightly different attitude to the
"GP patient" in that the patient perceives it to be an emergency so we will
see them
If a patient is willing to wait an indeterminate time to see me then i am
prepared to see them.I will in fact admit 5% of our triage catgory 5
patients(non urgent to be seen within 2 hours of arrival)
They come because of either financial reasons/inability to see their
gp/inability to find a gp/or because they regard the care that they will
receive in my department as unable to be provided by their gp to be
superior to that of their gp
This last is the aim that we are striving for i.e to be recognized in our
community as a centre of excellence that provides timely,superior care.
I will be working in it for the next 25 years(burnout permitting )so I'm
training all of my residents out of the attitude that has been expressed by
others on the list.
I have to work there and live in this community.I want my workplace to be
regarded as the highest quality within our region so my children are happy
to say that their dad works in the ED
Local GP's already refer patients to the department for an opinion by
myself or the other consultant rather than a physician or surgeon.We must
be doing something right.
The concept of the gomer belongs back in the 80's when the book was
written.Contemporary emergency medicine does not piss every patient off but
tries to provide adequate care for them all
Dons asbestos underpants and stands with fire extinguisher at the ready
anticipating statements about funding space staffing and workloads
looks back and figures out that it has been a long day and i seem to be on
a hobbyhorse
cheers
shane
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