From: Robbie Coull <[log in to unmask]>
> You can play with yourselves all you want re: getting the patient into a
bed
> within an hour etc.. But if the GP is getting a visit request at 9am, for
a
> fall that happened at 2am, and then visits at lunchtime and is sending
them
> in by ambulance as a "within 2 hours" category and you're pulling out all
> the stops in A+E to see them within 10 minutes of arrival then what you
are
> doing makes no sense at all.
Surely these are the very patients we should be pulling out all the stops
for! If this poor patient (probably elderly) fell approximately 12 hours
before their arrival in A&E then why should they be penalised for delays
caused by others. In this example, perhaps the patient wasn't found till
9am, the GP compounds the delay, the Ambulance service they again adds to
the delay - it doesn't follow that because delays have already happened it
is safe or right for those of us who work in A&E to continue to add delay.
The patient on arrival in A&E should (and indeed would) be triaged by an
experienced triage nurse and assessed on the clinical picture presented at
that time. If appropriate e.g the patient is in a lot of pain, there is a
high risk of pressure sores developing, patient is in shock etc. then it is
quite appropriate that we should ensure that they are seen within 10 minutes
of arrival by a doctor. In the meantime in our department the patient would
have had appropriate x-rays ordered by the triage nurse and analgesia sorted
out if felt necessary.
There is nothing wrong with setting targets to get patients through a
department, providing they are realistic and that they take into account the
needs of other patients already in the department. We do not want to create
a two tier service, where if you have a certain type of problem you can
quickly pass through the system ahead of patients with a higher clinical
priority.
Just a few comments....
Mark Cooper
Researcher/Practitioner
A&E, Glasgow Royal Infirmary
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