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ACAD-AE-MED  March 2002

ACAD-AE-MED March 2002

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Subject:

Re: Initial medical assessment

From:

"Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR" <[log in to unmask]>

Reply-To:

Accident and Emergency Academic List <[log in to unmask]>

Date:

Mon, 25 Mar 2002 12:14:22 -0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (63 lines)

> It relies on the
> sporadic nature of attendance to allow the
> doctor to catch up; three people come in within 10 minutes
> and each takes 20 minutes to be seen.
> This works fine if nobody then comes in for an hour.

Application of queuing theory (possible once you know how long on average
each practitioner takes to see a patient- easier to work out with streaming)
allows you to figure out the probability (for example) of a patient having
to wait over an hour; and how changing staffing will affect this. You can
then let your purchasers pay for as good or bad a service as they want (they
have the costs for different numbers of staff and come to their own
conclusions as to how much a reduction in waiting time is worth).

> I digress. It all goes wrong if the level of attendance
> overwhelms this substitution of time for staff.
> Patient numbers slowly accumulate in the waiting room until
> such time as the inflow abates;
> normally between 23:00 and 02:00, depending on the type of
> department. There is then a large
> cohort of increasingly angry and usually sobering, usually
> young people who then cause problems.
>
> Now we are planning to use another doctor to see the patient
> before the nurse before the doctor.
> And that saves time, huh?

I've seen it work. In Stoke they used to sometimes send a third of their
patients away from triage. Improved staff morale because you didn't have so
many patients waiting. Took less time to see they patients because patients
are happier taking quick advice to see their GP next available surgery when
you tell them at triage than they are when they've been waiting for a couple
of hours. The idea (when it goes well) is that everyone is happier and less
stressed so the whole thing works more efficiently

> Come on guys, the King's new
> clothes are not purple. There has been a
> moratorium on SHO numbers since 1998. Staff grade posts are
> now being filled by people waiting for
> their SpR number, few people want Trust grade posts and every
> department I know needs more
> medical staff - full stop.

The trouble is (as the document says), it looks as though A and E
departments have been increasing staffing levels faster than attendances
have increased last few years; but waiting times have increased. Unless we
can persuade the politicians that this is not the case, it looks as though
we are becoming less efficient (so need to change our practices, not get
more money). There are ways we can make our service more efficient and more
pleasant to work in (early direction of primary care cases to appropriate
facilities; cubicles to see our own patients rather than being taken up by
patients awaiting beds; faster turn around on labs etc.). This document
gives managers the incentive to support these changes.

Matt Dunn



This email has been scanned for viruses by NAI AVD however we are unable to
accept responsibility for any damage caused by the contents.
The opinions expressed in this email represent the views of the sender, not
South Warwickshire General Hospitals NHS Trust unless explicitly stated.
If you have received this email in error, please notify the sender.

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