--- Craig Ellis <[log in to unmask]> wrote:
> Not to my knowledge. No one in Australasia
> would be overly impressed. Its taken as a given that
> consultant led services are better. Im sure John C
> (who is on the list - I think) in Dunedin (NZ) would
> be able to demostrate a similar picture with the
> consultant driven service he has developed there.
> This idea that "ED consultants on the floor dont
> improve care" is a unique British concept IMO. The
> rest of the world takes it for granted !!
May be they shouldn't!! Having spent a few months in
the US last year, working in a big teaching hospital
in Philadelphia, I can't say I was overly impressed
with the the consultant delivered service (every
patient had to be reviewed by an Attending Physician
in EM). While they did some things better than we do
(eg. penetrating trauma, but then they have lots of
practice!), a lot of the time I saw very rigid
protocol driven medicine, which any of the juniors
could have delivered. For example everyone with a
headache had a full blood screen, CT scan and neuro
consult. That didn't stop a 35 week pregnant woman
with a headache being sent away to come back in with a
While we would all like to think we make a difference,
otherwise we wouldn't do the job, here in the UK we
are soon going to have to prove it. Now comparing my
performance with the SHO's, I'm much quicker (I see
about twice the nuber of patients/hour than they do),
Have less missed fractures (we review all x-rays),
investigate less, admit less and have had fewer
complaints. Our audit figures show no difference in
survival to discharge for resus, but I haven't looked
at other factors, analgesia, time in dept., days in
ITU etc. We also try and get our SHO's up to speed on
resus as quickly as possible and they all have 1 to 1
teaching in resus whenever we can. I pull the SHO's
off minors and into resus with me and not worry too
much about the waiting times!
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