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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!