Rowley,

Its not just the experience and training of SHOs you should be worried
about, what about new SpRs.  With the trend to completely separate minor
injuries from the rest of the department and have them seen by ENPs, there
is less opportunity for middle grade exposure to these problems.  Also, and
probably quite rightly, with increasing input to trolley patients and resus
cases by middle grades their time is eaten up with this type of care.  What
will be the knowledge of minor injures etc be of new consultants in A&E in
10 years time?  Some might say that they do not need this experience and
Nurse consultants will take this role over completely by then, I'm not so
sure.  Now, when ENPs get a case that is tricky, unusual or outside
protocols they tend to look for an experienced doctor for help.  Also, what
of the multiple injury patient who has a fractured femoral shaft, minor head
injury, dislocated little finger and a laceration of his upper arm.  Will
the ED Doc manage the fracture and call the ENP to deal with the 'minor
injuries'?

Just some thoughts from one of the last with 'old style training'!

Simon McCormick

P.S.  Do you think the public/courts are ready to call on Nurse Consultants
as expert witnesses in cases involving minor injury standards of care??


----- Original Message -----
From: Rowley Cottingham <[log in to unmask]>
To: <[log in to unmask]>
Sent: 23 November 2002 18:52
Subject: Re: See and Treat


> See and treat can help immensely in minors; however, the gain is almost
> entirely from one simple change; empowering the assessment nurse to
> treat there and then and discharge or simply to turn the patient away
> untreated (i.e. the self-help stream). That is not a trivial change to
> implement and essentially needs an ENP. The only thing required after
> that is a defined escalation policy and escalation levels. However,
> several of us are uneasy about the change in the case mix, experience
> and training of SHOs which nobody seems to have thought about.
>
> R
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of
> [log in to unmask]
> Sent: 23 November 2002 18:12
> To: [log in to unmask]
> 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
> >
> >
> >
>