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Sir George Alberti did come across as informed and understanding (and most of all realistic). Either a convert or modified his views for the audience before him. I actually think the former but time will tell. Simon Simon Carley SpR in Emergency Medicine [log in to unmask] Evidence based emergency medicine http://www.bestbets.org ----- Original Message ----- From: "A S Lockey" <[log in to unmask]> To: <[log in to unmask]> Sent: Wednesday, November 27, 2002 11:32 PM Subject: Re: See and Treat > Rowley - at the FAEM conference in Plymouth, Sir George Alberti agreed that > the 4 hr turnaround is impractical and dangerous in some cases (e.g. > asthmatics waiting review after nebs, awaiting CDU investigations that may > avoid admission etc). He intimated that this 'target' is going to be > revisited and stratified so that it is only pertinent to conditions that you > would expect not to be in the department for longer than 4 hours. > Incidentally, he seemed to talk a lot of sense and also LISTENED to views > and opinions. I must admit to being sceptical about a non-A&E doc taking on > this role but I was pleasantly surprised by his enthusiasm and knowledge and > feel more comfortable about his involvement. Another comment made that he > made note of was the complaint that we are being constantly bombarded with > new strategies and that we are only just getting to grips with streaming > when "see and treat" is coming in. > > Incidentally, in our unit, we do not need to talk to medical SHOs to admit > medical patients. We have an agreement that if any A&E doc thinks a patient > should be admitted medically, the nursing staff pass the details on to the > MAU and the patient gets admitted. If the A&E doc is unsure or feels that a > more immediate opinion is needed, the medical middle grade then sees the > patient in A&E. Surprisingly, this works very well. There are very few > inappropriate referrals and the few that do slip through are accepted by the > medics as inevitable with such a system. Most importantly, there are no > battles with junior medics over admissions and no copious amounts of > needless investigations to justify a referral. > > Naturally, our version of Utopia still has a hospital with too few beds! > > Andy > > -----Original Message----- > From: Accident and Emergency Academic List > [mailto:[log in to unmask]]On Behalf Of Rowley Cottingham > Sent: 27 November 2002 23:12 > To: [log in to unmask] > Subject: Re: See and Treat > > Thank you John; you bring me on to another issue with which I disagree - > the UK Government have decided to set targets for patient transit > through Emergency Departments. Next April 90% of patients are to be out, > April 2004 100%. I have great clinical unease about this - there are > seriously ill unstable patients who may take more than 4 hours to sort > before they are safe to move. I know of no clinical evidence that there > is benefit to this, and I meant to take this up with the advisers. I > know Mike Lambert reads this list, and I think my friend Matthew Cooke > looks in occasionally too. Matthew - can you bring my clinical concerns > to the DH and try and get it stopped at the 90% 4 hours level and say > 100% at 8 hours? > > After all, you can wait 4 hours in an airport lounge between flights and > no Government is jumping up and down about it! > > R. > > -----Original Message----- > From: Accident and Emergency Academic List > [mailto:[log in to unmask]] On Behalf Of John Chambers > Sent: 27 November 2002 22:54 > To: [log in to unmask] > Subject: Re: See and Treat > > > The problem is that in patient beds are always under pressure and > medical and surgical registrars have this optimistic hope that by the > time they see a referred ED patient the symptoms and signs will have > vanished and the patient can be discharged - and this does happen in a > few patients each day, time is a great healer! You must have some > sympathy of registrars from the in patient specialties . They are given > a hard time if they "fill" the wards with "soft admissions" both from > their own bosses and their hard nosed peers. They do not really care or > lose sleep worrying what the ED middle grade staff think about them. > Conversely if the ED staff could admit and seemed to be filling the > wards with "soft admissions" Rowley's prediction is quite right - the in > patient specialists would simply refuse to take responsibility for these > patients. Our ED works as the "hub" of the hospital where all the > referral and admitting takes place. Patients only go to the ward with > all drugs charted and treatment plan complete. Works pretty well but you > do need staff and space. We work as a team alongside specialty > registrars and try and avoid duplicating the same steps of the admitting > process. Simple quick direct ward admissions by ED middle grade and > senior staff are a bit of a dream rather than an achievable reality - > would come back and bite you big time. JohnC PS in many Australasian > Hospitals there is rather too much repeat clerking. The grass is not > always greener!! > > > > > > -----Original Message----- > From: Brendan Conway [mailto:[log in to unmask]] > Sent: Thursday, 28 November 2002 11:31 a.m. > To: [log in to unmask] > Subject: Re: See and Treat > > > I'm re-sending this as it didn't appear on the list... > > The single best way to reduce inpatient waits is for A&E middle grades > and consultants to have the authority to admit patients directly to > wards. This would have a dramatic impact on patient comfort, reducing > trolley occupancy, and preventing work being repeated. The current > system of clerking after clerking is a mess! > > Opinions, please! > > B Conway > SpR Medway > > I'm using Vodafone Mail - to get your free mobile email account go to > http://www.vodafone.ie Use of Vodafone Mail is subject to Terms and > Conditions http://www.vodafone.ie/terms/website > ###################################################################### > > Attention: > This e-mail is privileged and confidential. If you are not the > intended recipient please delete the message and notify the sender. > Any views or opinions presented are solely those of the author. > > ###################################################################### >