Simon, I am alarmed by your comment about rules that prevent you sending the elderly fallen home without a physio/social assessment, as I fear we are drifting in that direction in North Bristol. 
Can you tell me more, as this is sounds like a good way to cause unnecessary admissions through well meaning 'pathways'

Thanks

Steve Meek

From: "McCormick Simon Dr, Consultant, A&E" <[log in to unmask]>
To: [log in to unmask]
Sent: Monday, 7 January 2013, 16:47
Subject: Re: Social admissions

Vic,
 
I’m not sure Matt was necessarily attaching any blame to the doctors in Primary Care!
 
I think all of us are seeing a steady increase in the ‘social’ admissions and like Vic, struggle to send people home because of the concerns about ‘what happens if??’ when you have touched the patient last.  We find ourselves further restricted by other rules put in place such as nobody over 70 being sent home after 10pm and those with a fall requiring physio/social assessment and/or input before discharge.
 
Added to that, we have community hospitals/homes etc made available but then are told nobody who is confused or likely to fall can be admitted to them (which rules out 80% of our elderly attenders) and also that nobody who might deteriorate can be admitted either (well none of us are getting any younger/better so that takes out the other 20%).
 
Elderly population increasing + raised expectations of life + desire to keep money in our own pockets + short term politics = reduced ability to meet needs of the elderly.
 
Roll on Revelation 21:4
 
Simon
 
 
 
"Hospitals with overcrowded Emergency Departments are overcrowded hospitals that have chosen to manifest the overcrowding in a single location" 
Full Capacity protocol: an end to double standards in acute hospital care provision Emerg Med J 2011;28:547-549
 
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Victor Calland
Sent: 07 January 2013 15:46
To: [log in to unmask]
Subject: Re: Social admissions
 
John 12:8 and Deuteronomy 15:11 both acknowledge there will be poor always, and traditionally doctors did what they could for the poor with free treatment, and the rich accepted their bills helped cover the cost of those acts of charity. Modern politicians are a Godless lot.
 
Now general practitioners are castigated if they do not provide the same level of care to Vulnerable Persons as to anyone else, but at this time of the fiscal year the Social Services annual budget is now gone, if not overspent. We have no option to admit if we feel the patient will potentially deteriorate or die if left at home. The relatives that never visit will be the first to contact the  Compensation Solicitors if the old bastard dies because "we're traumatised at the loss of er, whotsizname?". 
 
Our answer of course is to admit the chap, so that when you finally get him home, or in to a home, the blame falls on your shoulders. If you want us to stop it just persuade someone to open up the old cottage hospitals again. We don't send them in for your medical care and we certainly think twice about sending them in for nursing care - such as it is. We send them in because everyone kicks our arse if we don't!
 
 
Vic Calland
 
In training for the World Grumpy Old Man record
 
On 7 January 2013 13:52, Matthew Dunn <[log in to unmask]> wrote:
Not necessarily the best term, but at the moment we seem to be getting a lot of these: elderly patients with inadequate care at home. I expect it in the run up to and during the Christmas period, but not to the same level as we're getting at the moment this late. Is it just us or is anyone else getting the same?
 
Matt Dunn
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