 |
 |
The list may like to visit the Web Site below. http://www.doh.gov.uk/capacityplanning/makingprogress.htm Looking into the future I'm not sure how any department can have ALL patients discharged or admitted within 4 hours. Our statistic in Lancaster is 96.4% for 2000. It would be difficult to recruit the staff and financially very expensive to staff departments to cope with peak demand at all times. Unless we have staff on call to firefight waiting times (No, I'm not supporting that). Alternatively when the waiting times for minors increase we divert staff from patients more seriously ill which goes against the idea of Triage. The other problem is getting in-patient teams to see patients and then get beds. Both are outside our control. In Lancaster we have had a policy to admit the patient if the in-patient team have not seen the patient within 1 hour of referral. Only seniors can do this for obvious reasons,.... but then of course we have to find a bed! In addition there can be occasions when the patients progress is delayed in the department for clinical reasons. Treatment of Colles fractures, use of ketamine in children not starved on arrival (3 hr cut off). A child having ketamine usually stays in the department 60 to 90 minutes from time of injection. A nurse only needs to observe them for the first 30 minutes, but getting them out too fast may make them more likely to vomit in the car home! If there isn't some common sense here I predict interesting ways of getting around the 4 hour rule e.g. patient can't be treated now, therefore discharged and told to come back as a return in an hour. This has been done before when Nurse Triage was introduced with a 100% target. So departments put Triage before registration so the system couldn't demonstrate that the patients had been waiting to be Triaged! So perhaps we should aim for 100%, but have a bit of common sense about it. Some of the list will have noticed that the audit department was recording 100% (arrival to discharge in 4 hours) being reported by some Trusts. I think that needs to be audited! Happy Christmas Ray McGlone "Of her,Emmanuel, the Christ was born In Bethlehem, all on a Christmas morn, And Christian folk throughout the world will ever say "Most highly favoured lady!" Gloria!