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Can I ask others on the list how many also work in ED Depts where requesting CT Scans has to be Consultant to Consultant? We do - in hours, this is not a problem but out of hours it is a pain - leads to delays, and risks "Chinese Whispers" information (as relayed to me by one of the ED Middle Grades) then having to be given to the Radiologist by me if I am not on site. There are occasions when I feel that it should actually be the Specialty Consultant requesting the CT, when it is that Specialty which feels a CT is necessary - but that is another issue. Mike Dudley EM Consultant Airedale PS. Sorry Phil for hijacking your e-mail ! a.. Yes we look at our ED deaths, and also contribute to the Trust Mortality and Morbidity Meetings. b.. No - we do not have a breach avoidance unit (and we would probably be classed as a comparator site to you? (DGH - 50k patients/yr). c.. Freemantle - great place, but getting expensive to live there, and no English beer! ----- Original Message ----- From: Mark Nicol To: [log in to unmask] Sent: Saturday, March 21, 2009 8:37 PM Subject: Re: Stafford Hospital I think there will be many many trust boards shaken by the criticism that focus on targets, focus on balancing the books, and focus on achieving FT status all appear in practice / behavior and time spent on meetings, to be more important than clinical outcomes.The problem is that "target" has come to be perceived as operational targets eg.4hr or 18week as opposed to the clinical target such as thrombolysis DTN CTN which still applies to us. Can I ask how many of you routinely scrutinise deaths in ED...with an aged department some feel this may be waste of time...I recently got calleda t home 40min into resus of young woman who saw GP preious day with unilateral calf pain...ergo ?collapse form PE which is still on my conscience from not having a junior quick enough to call me sooner and deliver thromobolysis. Having been typecast as "4hr lead " by many for past 6 years, I devoted the whole of ED team meeting to revamping our focus for future meetings. We do not provide consisent triage but have none of the horror stories stafford had.We do not deliver the focus on early warning scores as we should in the broader emergency acute medicine domain, but will. We do have a breach avoidance unit but I have yet to visit a dept.that does not have a breach avoidance unit. (I visited 4 comparative departments back end of last year:hereford, salibsury, yeovil, taunton.) We do have a facilitative radiology colleagues, with 1 isolated exception who has been associated with the stafford flaw of "consultant to consultant" referral. So there are many things we can, and many others I suspect, can learn from this healtchare commission lobbed grenade. As far as staffing ..I hope hope John heyworth seizes the oportunity....I received the latest adverts from australian department advertising for new specialists (as I am FACEM)..freemantle is identical to us in case laod, but not case mix: they have 16 wte FACEMS, we have 2 wte, 2 part time and 1 assoc spec; 17 registrars....we have 2 reg and 6 middle grade(..before 3 go to GP for better moneyless nights, fewer weekends)..freemantle has 15RMOs...we have 8 FY2s