--- "Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY -
SwarkHosp-TR" <[log in to unmask]> wrote:
> Alerting the consultant by predefined criteria
> (sounds like Phil's are more
> rigidly enforced than mine, so should work better)
> means the consultant gets
> called before the patient deteriorates (if they
> deteriorate in the
> department) or before people get in too much of a
> flap if they're brought in
> sick. A bit of advice over the phone if they're
> already sick helps; if
> they're on the point of going over the edge you've
> usually got time to get
> in before they crash. OK, having a consultant on the
> floor 24/ 7 might be a
> better idea (although might not- as I say, I have my
> worries about de-
> skilling of the individual with that sort of
> number), but failing that, a
> rapidly available consultant 24/ 7 is probably
> better (and cheaper) than a
> consultant on site in the evenings but an
> unsupervised SHO (or inexperience
> middle grade) overnight.
> The trick is to set it up so you are alerted about
> patients before they
> crash (you usually have a certain amount of warning
> about this). There are
> simple physiological scoring systems around -or use
> something like Phil's
> criteria- that allow you to do this.
> Emergency medicine may be moving away from the model
> of the consultant
> dashing in to save lives. I'm not sure this is a
> good thing, though.
>
The problem I see with this is it is not always the
sick patients they screw up on. It also implies that
less ill patients don't justify consultant care. Of
the balls ups that I've seen over the years few have
involved really sick patients - to start with! A
recent example was a 20 something cyclist who came off
his bike and landed on some gravel, lacerating his
left elbow. Seen by quite an experienced SHO on the
surgical rotation who cleaned and dressed the wound.
When I saw him 2 days later and X-rayed him he had
subcutaneous gravel halfway up his forearm and early
gas gangrene! That cost the trust a few grand! Most of
the big payouts have been for similar things, missed
diagnosis or suboptimally treated conditions that have
deteriorated and caused the patient harm.
Cheers Fred.
__________________________________________________
Do You Yahoo!?
Yahoo! Health - Feel better, live better
http://health.yahoo.com
|