In message <[log in to unmask]>, [log in to unmask] writes
>There are two large teaching hospitals in Belfast. If a GP thinks a patient
>needs admission as an emergency, he/she sends them to the AED In one hospital
>(RVH) - the system is that our AED doctor of any grade decides if the patient
>does need to come in, to which specialty, and admits the patient.
So a GP with say 30 year's experience refers to an A&E SHO who was until
yesterday a Pre-Reg HO, who can decide whether the GP's clinical
impression is correct or not, then wards the patient (or discharges
them). Several hours down the line, the patient then gets seen by the
specialist who the GP wants them seen by in the first place. Hmmmm.
> There are a
>few exceptions (cardology and neurosciences) where the specialist is consulted
>first, but they give a very good service and respond very quickly.
You are indeed blessed.
Depending on who's on-call, referrals to our neurosurgeons goes like
this:
patient seen by GP, who spends 30 minutes on the phone trying to
directly refer,
neurosurgeons in theatre, pass message back refusing to accept patient,
suggesting send to A&E, fruitless discussion via intermediary.
GP gives up, sends to A&E (who give the GP a hard time for inappropriate
referral),
patient waits 2 hours to be seen by spotty adolescent youth, who spends
30 minutes on 'phone trying to refer patient,
neurosurgeons are in theatre, pass message bcak refusing to accept
patient unless first seen and investigated fully by medics / surgeons as
appropriate,
spotty youth gives up, refers to medics who are in clinic,
medics finally see patient 4 hours later and refer to neurosurgeons who
grudgingly give permission to use THEIR CT scanner, which confirms all
is well and patient can go home (6 hours delay).
> In the
>other hospitatl (BCH) the AED doctor sees the patient. If he thinks the
>patient needs admission, the in-house SHO has to come and see the patient in
>the AED, making the final decision.
Couple of observations:
The more hurdles / tiers there are, the slower it will be.
Whatever system in place falls over if you have:
1) NO BEDS to decant people to, so the world and its dog backs up in A&E
(preventing good quality early management) and
2) INACCESIBLE specialists, through over-work or poor organization (our
on-call orthopods are invariably in elective theatre all day!)
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Dr. Gautam Ray (e-mail: [log in to unmask])
Sussex, U.K.
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To err is human, to forgive is not management policy
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