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James,

 

We did start with Reg to Cons requests but unfortunately the Medics played silly buggers on day one of implementation and therefore we went back to Cons to Cons.  Personally (even though the 3am ones get a bit tiresome!), I don't have a problem with Cons to Cons requests.  It means that I can speak to our Reg and discuss cases first.  I think they appreciate the opportunity to discuss.

 

Sunil

East Surrey Hospital

Redhill

 

-----Original Message-----
From: James Cameron [mailto:[log in to unmask]]
Sent: 10 March 2006 21:12
To: [log in to unmask]
Subject: Re: Inpatients with Head Injuries

 

day and night (we also have a consultant to consultant referral for ordering CTs and we follow NICE.  The radiologists know that we don't order scans unless we have to and so we don't really have any arguments about any requests at all)

 

 

Why does it have to be an Emergency Medicine Consultant who requests the scan from the Radiologists in a patient who needs a CT head and conforms to the NICE guidelines?

 

Why can't it be the Registar? Or, for that matter the SHO, so long as they have confirmed with their registrar first?

Why wake up a Consultant at 3am to call the Radiologist, why not speak to them directly? It seems unnecessary for any request that falls within the NICE criteria.

 

Do the Radiologists think - 'Well if I'm going to be woken up, so is the EM Consultant' ? If the Orthopaedic team said from now on we want all A+E referrals to come from the Consultant would that be appropriate? Presumably the Medics know you don't refer patients to them unless you have to and don't argue either?

 

I know of one hospital where they've simplified matters - the radiographer confirms the request is according to NICE guidance and does the scan - the radiologist only has to be contacted in time to come and look at it.

 

I think with CT and now with interventional radiology, the Radiologists may have to realise they've ended up in an acute specialty. The alternative is Emergency Medicine having their own CT, reporting their own scans, to be reviewed by a neuro-radiologist via the internet in another country during their day. Then the radiologists will have argued themselves out of a job completely!

 

 

James Cameron.

EM  SpR

 

 

 

 

----- Original Message -----

From: [log in to unmask]">Sunil Dasan

To: [log in to unmask]">[log in to unmask]

Sent: Friday, March 10, 2006 3:38 PM

Subject: Re: Inpatients with Head Injuries

 

We look after all adult head injuries who:

1.Don't need transfer to a neurosurgical unit

2.Have no other injuries which require admission under another team (If they do they go under that specialty to an in-patient ward)

3.Are not intubated (if they are, ICU)

4.And who are likely to go home within 24 - 48 hours (therefore usually with a normal CT.  If abnormal CT or GCS <14, we assume a stay of greater than 24-48 hours and they go to General Surgeons)

 

We took on head injuries after the orthopods (who were looking after them at the time) were threatened with having the training recognition for their SpRs withdrawn if they continued (therefore we didn't instigate the move from ortho to EM). 

 

We argued that we needed 24 hour middle grade cover to take on this responsibility, and we got it (admittedly with the creation of clinical fellow posts).  I was also happy for us to take this on as I had witnessed some less than ideal management decisions being made by orthopaedic juniors and disinterest from their seniors and I was happy that we would provide a better service.

 

That was over a year ago and things have gone well (sorry, we have such a crap IT system that I have no figures whatsoever!)  My general impression is that the care for these patients has improved, that our staff have now developed an 'expertise' (or at least a good knowledge) in this area and that we run a safe service.  As a by product, it has also improved the street cred of EM considerably and has also improved our access to radiology across the board, for all tests, day and night (we also have a consultant to consultant referral for ordering CTs and we follow NICE.  The radiologists know that we don't order scans unless we have to and so we don't really have any arguments about any requests at all)

 

All in all, I would say it is probably not 'core business' and would not advocate all EDs taking this on.  For us it has been very good as we used it as a lever to improve the service overall and it has achieved that.

 

If you want more info, contact me off list.

Sunil

Redhill

 

-----Original Message-----
From: Reid, Cliff [mailto:[log in to unmask]]
Sent: 08 March 2006 17:30
To: [log in to unmask]
Subject: Inpatients with Head Injuries

 

Anyone working in a unit where the emergency physicians look after all inpatient head injured patients?

 

Would be grateful if you could share your experience of the pros and cons.

 

Cliff Reid

Basingstoke

 

Disclaimer - March 8, 2006

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