Paranoia rules and rightly so.
Historically, for reasons that happened before I arrived and so do not fully
understand, we have had a number of cubicles designated "beds" for some time
in the department here. Recently, following some very difficult times, we
requested the CEO to rescind this definition and to own up to all breaches,
whatever cubicle they were in. This is clearly the honest and obvious thing
we should be doing.
Unfortunately it has rebounded on the CEO with some force, and the resulting
pressure on the Trust has been extraordinary as we suddenly had to report
upwards of 5 breaches a day. It has been beneficial to A&E because it has
focussed the Trust on the bed issue, but the pressure from Region to prevent
the "bad publicity" has been laughable. I agree the new definition is
dodgy, and of course if all patients total time is less than four hours,
then DTA to bed is not a time to really be worried about as it is within the
window of four hours anyway.
I do believe that it is time that we all, health care professionals and
management, started being honest about our own hospitals performance, if all
hospitals decided to take the plunge and stop lying by "fudging" the
figures, then Region and NHS Exec could not do anything about it. It is
only when individual hospitals don't play the game that Region can penalise
them and therefore create the atmosphere of collusion that we all live in.
If only, for example, all CEOs in London would agree to report the actual
times in the department, rather than participate in the deception, then
Region could not pick on any one hospital.
Brothers unite! (guess not many of them read this board?)
Dr Ruth Brown
Consultant in A&E Medicine
-----Original Message-----
From: Goat [mailto:[log in to unmask]]
Sent: Sunday, October 28, 2001 3:34 PM
To: [log in to unmask]
Subject: audit commission report - how targets will be met
In article <[log in to unmask]>, Francis Andrews
<[log in to unmask]> writes
>The list seems to have ben silent regarding the publication of the
>latest audit commission report on A&E so here goes.
There's another item which I'm even more surprised hasn't received
comment.
Either I've completely misinterpreted the following, or its been very
well "buried" (to use a Jo Moore-ism)
The latest SitRep interpretation, as clarified by our RHA, has far-
reaching implications....
I, as A&E clinician, am being asked to agree which areas in A&E are
"appropriate" for patients to be managed on beds. According to the
"equivalent to a ward environment" interpretation we have had from
Region, this includes most of the Department.
Any patient put on a bed in one of the areas that I have been implicated
in identifying as "appropriate", will NOT count as "waiting for a bed".
Such a patient will effectively be deemed to have been admitted to an
appropriate area.
If I have misinterpreted this, then please let me know a.s.a.p because I
feel inclined to draft a letter expressing my concerns to management.
In the state of permanent crisis we are in with beds, I can accept the
need to identify such overflow space as a temporary emergency expedient.
However, I feel I am being asked to collude with what appears to be a
cynical attempt to re-define a bed wait. If this re-definition is made
to stick, my Trusts next SitRep data will report 100% compliance with
trolley waits < 4 hours, as opposed to the current figure (79%, gloat,
gloat)
Another perceived risk is that I would be "rubber stamping" the de facto
conversion of much of the Department into an in-patient ward. Now we all
know this happens routinely in our neck of the woods. But that doesn't
make it acceptable and I'd rather not be complicit in legitimizing it.
Am I being paranoid? Luddite? Cynical?
I would value your collective opinions, and urgently.
Danny once warned me there are politicians and journalists lurking on
this group - good. I'd like to hear their views too!
Gautam Ray
Dr G Ray
A&E
Sussex
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