It has been said that one should study history to avoid making the same
mistakes, so a quotation from the time of the Emperor Nero might be
appropriate.

"We trained very hard, but it seemed that every time we were beginning to
form up into teams, we would be reorganised, I was to learn later in life
that we tend to meet any new situation by reorganising and a wonderful
method it can be for creating the illusion of progress, while producing
confusion, inefficiency and demoralisation."

Gaius Petronius (A.D. 66)

In order to prevent Triage slowing the sytem down we have the A&E card
printer at the nurse station in the central area. So if the doctors are free
they can bring patients into a cubicle straight away (triaged by the
doctor). About 95% of our patients are discharged within 4 hours yet a man
from the "Ministry" came saying we would have to change things.... again. No
doubt it will all be changed again in another few years.

Ray McGlone
About 73 Roman Miles South of Hadrian's Wall




----- Original Message -----
From: "Adrian Fogarty" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, November 23, 2002 8:09 PM
Subject: Re: See and Treat


> Yes Danny and Andy, I'm still not sure what this "see and treat" is all
> about yet, but am on the workshop this Thursday I think. I can certainly
see
> the advantage of Rowley's idea of redirection to self-care, as it's
> euphemistically known!
>
> Returning to triage, I see its role as pivotal now, but not for the
reasons
> for which it originally arose 10 years ago. The modern triage nurse
> "front-loads" the patient's observations, investigations and management.
Not
> only is the patient prioritised and directed, but their investigations are
> ordered (x-rays/ECGs/urinalysis etc) and treatment is often commenced. By
> the time the doctor/ENP sees them the consultation is now more compact,
i.e.
> the patient is seen with all of their observations and investigations
> already completed, so rapid decision making and management are possible in
a
> single, and briefer, patient "encounter".
>
> If "see and treat" means a senior doctor combined with a nurse scything
> rapidly through minors, then surely this would work best at the "back
end",
> i.e. with those patients who've already waited for several hours, in
> response to certain triggers perhaps, to restore order to a busy
department
> and to prevent patients going over the magical four-hour mark. I expect a
> senior doctor "greeting" the patient in triage will come across a large
> percentage where a decision will be delayed pending preliminary
observations
> or investigations (this is relatively easy to audit), so the senior
doctor's
> expertise will be somewhat frustrated at the very "front line". Also to
have
> dedicated consultant time in triage will require at least double the
> consultant numbers that were recommended by BAEM in 1998 (which many of us
> have yet to reach in 2002). What do others think?
>
> Adrian Fogarty
>
> ----- Original Message -----
> From: <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Saturday, November 23, 2002 6:11 PM
> Subject: Re: See and Treat
>
>
> > I attended the Leeds "See and Treat" bunfest.
> > The co-ordinator or whatever she was patronised us to hell and beyond. I
> > have experience of her style from her former life in A&E!
> > The general feel from the clinicians on the floor was that with adequate
> > staff levels, exercises such as see and treat would not be required.
> > The demand to do this as well as take on ECL,Streaming, Education, Audit
> > and see patients and manage a department is excessive.
> > The presentations I saw were for the use of ENP's managing the minor
> stream
> > with a nominated middle or senior clinician, and another for a dedicated
> > minor side.
> > We had a dedicated minor side in Sheffield at the Hallamshire and Hull
for
> > years but still would get overloaded when the numbers rose.
> > I have three MIU's run by ENP's who also get overloaded.
> > We have never Triaged in Scarborough because we have never had enough
> > staff. Now they tell us Triage is passee! I never thought of it as I
have
> > seen it performed, as anything other than a crowd management tool. I am
> > trying to install "Empowered Triage" which is realy low level ENP
function
> > on protocol.
> > The only real way to cope with the patient numbers is to have Expensive
> > Trained clinicians, ENP or Medical of sufficient numbers and seniority
so
> > that we can assess and treat. Where is the miracle cure in that?
> > APV
> >
> > >Colleagues
> > >I see from the attendees list that there was a large turn out for
> > yesterday's study day in Manchester on the above topic.  Unfortunately I
> > couldn't attend.  Through the list I would like to canvas people's
> > opinions.  Without wishing to offend some of the quasi acaedemics who
seem
> > to flourish on this list I will keep my own council but I would value
> other
> > comments.
> > >
> > >Danny McGeehan
> > >
> > >
> > >