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> Streaming of some groups of patients past or through the ED has been > suggested by one or two managers in this neck of the woods. The A&E > Consultants are resisting this and we have the full support > of our local > GPs in our preferred option which is to move in the opposite > direction. > That is to funnel all emergency care through the ED and have a single > A&E Consultnat led emergency team. I think there are 2 issues here: whether patients should be identified early for admission; and whether they should remain under the care of the ED once that decision has been made. It is clearly beneficial that patients requiring admission be admitted to a ward as early as possible after physiological stabilisation. This does not preclude their remaining under the care of the Emergency team and is entirely compatible with an expansion of our role and numbers. Regardless of the speciality looking after these patients, it appears to me that there is a substantial group of patients for whom (if we are to have the most cost effective use of our senior staff), senior review after certain investigations according to protocol (or possibly after a period of observation) is likely to be more cost effective than immediate senior review. There are other groups of patients who are physiologically stable, but unfit for discharge (or require review by a speciality other than A and E prior to discharge). An expansion consultant numbers sufficient to provide and entirely consultant delivered service is unlikely in the near future. Prioritisation of senior staff is therefore important. In my view, the highest priorities (i.e. the cases where the most difference will be made) are critically ill patients and complex minors rather than general trolley cases or simple walking wounded. Matt Dunn Warwick This email has been scanned for viruses by NAI AVD however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust unless explicitly stated. If you have received this email in error, please notify the sender.