I agree with this trend, but would go a step further. Why do "routine" bloods on the pilonidal abscess at all? Granted, you're not delaying the admission, or the decision to admit, because of the bloods, but it's still 5-10 minutes' wasted time for your junior just taking the bloods and sending them off (and reinforces their belief that all cases MUST have blood tests done). If the anaesthetists really want these results preoperatively, and I very much doubt it, then the surgical house officer should do them as part of his work up for theatre, rather than the Cas SHO doing them as part of his work up for admission.
Partly, although our SHOs are very strongly taught that this is not
acceptable from the specialists. However, I think the main reason seems to
be that they feel they have to do everything before making any decision!
--> I think you are correct about the main reason being indecision, which is
how things are improved by middle/senior supervision. BTW, the ONLY benefit
of these thumb-sucked targets we have to live with is that they have
eliminated most problems with specialists delaying action for results,
mainly by forcing the on-call SHOs to be "resident" in the ED or virtually
so, which prevents any "benefit" to him from delaying. It also helps when
you teach juniors a new pattern...
Old one: HX&Exam -> Ix -> Wait -> Results -> working/final Dx -> refer
New one (when possible - which is most of the time, not
all):
Hx&Exam -> Decision that patient will not be discharged -> refer and discuss
with accepting team what Ix THEY need -> Have Ix done while accepting team
wanders over, but IN THEIR CONSULTANT's NAME AND COST CODE, as the Ix was
not necessary for the ED decision, only required by the specialist team.
e.g. from 5 minutes ago:
Pt. presents with c/o what sounds like pilonidal sinus -> Triage nurse puts
in cubicle -> SHO casts an eye quickly + 5mins focused Hx&exam -> Call
surgeon and hands case over to them by phone, as requires admit and I&D
today -> THEY want FBC, U&E -> Bloods sent under code of consultant surgeon
of day AFTER case already accepted.
