JiscMail Logo
Email discussion lists for the UK Education and Research communities

Help for ACAD-AE-MED Archives


ACAD-AE-MED Archives

ACAD-AE-MED Archives


ACAD-AE-MED@JISCMAIL.AC.UK


View:

Message:

[

First

|

Previous

|

Next

|

Last

]

By Topic:

[

First

|

Previous

|

Next

|

Last

]

By Author:

[

First

|

Previous

|

Next

|

Last

]

Font:

Proportional Font

LISTSERV Archives

LISTSERV Archives

ACAD-AE-MED Home

ACAD-AE-MED Home

ACAD-AE-MED  November 2002

ACAD-AE-MED November 2002

Options

Subscribe or Unsubscribe

Subscribe or Unsubscribe

Log In

Log In

Get Password

Get Password

Subject:

Re: See and Treat

From:

John Ryan <[log in to unmask]>

Reply-To:

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

Date:

Thu, 28 Nov 2002 00:00:39 -0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (171 lines)

Here Rowley,

How about this one from that chap Rudyard Kipling from down your way at
Rottingdean bewteen Brighton and Eastbourne:

 "Oh, East is East, and West is West, and never the twain shall meet,
Till Earth and Sky stand presently at God's great Judgment Seat;
But there is neither East nor West, Border, nor Breed, nor Birth,
When two strong men stand face to face, tho' they come from the ends of the
earth"

One of the messages coming through and re-inforced for me at Plymouth is
that See 'n' treat is not proscriptive and departments should cut the cloth
to suit themselves.

John Ryan

----- Original Message -----
From: "Rowley Cottingham" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, November 27, 2002 11:48
Subject: Re: See and Treat


> I was told about Sir George's remarks, but, cynic that I am, I simply
> thought of a certain previous speech.
>
> >From this day to the ending of the world,
> But we in it shall be remember'd;
> We few, we happy few, we band of brothers;
> For he to-day that sheds his blood with me
> Shall be my brother; be he ne'er so vile,
> This day shall gentle his condition:
> And gentlemen in England now a-bed
> Shall think themselves accursed they were not here,
> And hold their manhoods cheap whiles any speaks
> That fought with us upon Saint Crispin's day.
>
>
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of A S Lockey
> Sent: 27 November 2002 23:32
> To: [log in to unmask]
> Subject: Re: See and Treat
>
>
> Rowley - at the FAEM conference in Plymouth, Sir George Alberti agreed
> that the 4 hr turnaround is impractical and dangerous in some cases
> (e.g. asthmatics waiting review after nebs, awaiting CDU investigations
> that may avoid admission etc). He intimated that this 'target' is going
> to be revisited and stratified so that it is only pertinent to
> conditions that you would expect not to be in the department for longer
> than 4 hours. Incidentally, he seemed to talk a lot of sense and also
> LISTENED to views and opinions. I must admit to being sceptical about a
> non-A&E doc taking on this role but I was pleasantly surprised by his
> enthusiasm and knowledge and feel more comfortable about his
> involvement. Another comment made that he made note of was the complaint
> that we are being constantly bombarded with new strategies and that we
> are only just getting to grips with streaming when "see and treat" is
> coming in.
>
> Incidentally, in our unit, we do not need to talk to medical SHOs to
> admit medical patients. We have an agreement that if any A&E doc thinks
> a patient should be admitted medically, the nursing staff pass the
> details on to the MAU and the patient gets admitted. If the A&E doc is
> unsure or feels that a more immediate opinion is needed, the medical
> middle grade then sees the patient in A&E. Surprisingly, this works very
> well. There are very few inappropriate referrals and the few that do
> slip through are accepted by the medics as inevitable with such a
> system. Most importantly, there are no battles with junior medics over
> admissions and no copious amounts of needless investigations to justify
> a referral.
>
> Naturally, our version of Utopia still has a hospital with too few beds!
>
> Andy
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]]On Behalf Of Rowley Cottingham
> Sent: 27 November 2002 23:12
> To: [log in to unmask]
> Subject: Re: See and Treat
>
> Thank you John; you bring me on to another issue with which I disagree -
> the UK Government have decided to set targets for patient transit
> through Emergency Departments. Next April 90% of patients are to be out,
> April 2004 100%. I have great clinical unease about this - there are
> seriously ill unstable patients who may take more than 4 hours to sort
> before they are safe to move. I know of no clinical evidence that there
> is benefit to this, and I meant to take this up with the advisers. I
> know Mike Lambert reads this list, and I think my friend Matthew Cooke
> looks in occasionally too. Matthew - can you bring my clinical concerns
> to the DH and try and get it stopped at the 90% 4 hours level and say
> 100% at 8 hours?
>
> After all, you can wait 4 hours in an airport lounge between flights and
> no Government is jumping up and down about it!
>
> R.
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of John Chambers
> Sent: 27 November 2002 22:54
> To: [log in to unmask]
> Subject: Re: See and Treat
>
>
> The problem is that in patient beds are always under pressure and
> medical and surgical registrars have this optimistic hope that by the
> time they see a referred ED patient the symptoms and signs will have
> vanished and the patient can be discharged - and this does happen in a
> few patients each day, time is a great healer! You must have some
> sympathy of registrars from the in patient specialties . They are given
> a hard time if they "fill" the wards with "soft admissions" both from
> their own bosses and their hard nosed peers. They do not really care or
> lose sleep worrying what the ED middle grade staff think about them.
> Conversely if the ED staff could admit and seemed to be filling the
> wards with "soft admissions" Rowley's prediction is quite right - the in
> patient specialists would simply refuse to take responsibility for these
> patients. Our ED works as the "hub" of the hospital where all the
> referral and admitting takes place. Patients only go to the ward with
> all drugs charted and treatment plan complete. Works pretty well but you
> do need staff and space. We work as a team alongside specialty
> registrars and try and avoid duplicating the same steps of the admitting
> process. Simple quick direct ward admissions by ED middle grade and
> senior staff are a bit of a dream rather than an achievable reality -
> would come back and bite you big time. JohnC PS in many Australasian
> Hospitals there is rather too much repeat clerking. The grass is not
> always greener!!
>
>
>
>
>
> -----Original Message-----
> From: Brendan Conway [mailto:[log in to unmask]]
> Sent: Thursday, 28 November 2002 11:31 a.m.
> To: [log in to unmask]
> Subject: Re: See and Treat
>
>
> I'm re-sending this as it didn't appear on the list...
>
> The single best way to reduce inpatient waits is for A&E middle grades
> and consultants to have the authority to admit patients directly to
> wards. This would have a dramatic impact on patient comfort, reducing
> trolley occupancy, and preventing work being repeated. The current
> system of clerking after clerking is a mess!
>
> Opinions, please!
>
> B Conway
> SpR Medway
>
> I'm using Vodafone Mail - to get your free mobile email account go to
> http://www.vodafone.ie Use of Vodafone Mail is subject to Terms and
> Conditions  http://www.vodafone.ie/terms/website
> ######################################################################
>
> Attention:
> This e-mail is privileged and confidential. If you are not the intended
> recipient please delete the message and notify the sender. Any views or
> opinions presented are solely those of the author.
>
> ######################################################################
>
>

Top of Message | Previous Page | Permalink

JISCMail Tools


RSS Feeds and Sharing


Advanced Options


Archives

April 2014
February 2014
December 2013
November 2013
October 2013
September 2013
July 2013
June 2013
May 2013
April 2013
March 2013
February 2013
January 2013
December 2012
November 2012
October 2012
September 2012
August 2012
July 2012
June 2012
May 2012
April 2012
March 2012
February 2012
January 2012
December 2011
November 2011
August 2011
July 2011
June 2011
May 2011
April 2011
March 2011
February 2011
December 2010
November 2010
October 2010
September 2010
August 2010
July 2010
June 2010
May 2010
April 2010
March 2010
February 2010
January 2010
December 2009
November 2009
October 2009
September 2009
August 2009
July 2009
May 2009
March 2009
February 2009
January 2009
December 2008
November 2008
October 2008
September 2008
August 2008
July 2008
June 2008
May 2008
April 2008
March 2008
February 2008
January 2008
December 2007
November 2007
October 2007
September 2007
August 2007
July 2007
June 2007
May 2007
April 2007
March 2007
February 2007
January 2007
December 2006
November 2006
October 2006
September 2006
August 2006
July 2006
June 2006
May 2006
April 2006
March 2006
February 2006
January 2006
December 2005
November 2005
October 2005
September 2005
August 2005
July 2005
June 2005
May 2005
April 2005
March 2005
February 2005
January 2005
December 2004
November 2004
October 2004
September 2004
August 2004
June 2004
May 2004
April 2004
March 2004
February 2004
January 2004
December 2003
November 2003
October 2003
September 2003
August 2003
July 2003
June 2003
May 2003
April 2003
March 2003
February 2003
January 2003
December 2002
November 2002
October 2002
September 2002
August 2002
July 2002
June 2002
May 2002
April 2002
March 2002
February 2002
January 2002
December 2001
November 2001
October 2001
September 2001
August 2001
July 2001
June 2001
May 2001
April 2001
March 2001
February 2001
January 2001
December 2000
November 2000
October 2000
September 2000
August 2000
July 2000
June 2000
May 2000
April 2000
March 2000
February 2000
January 2000
December 1999
November 1999
October 1999
September 1999
August 1999
July 1999
June 1999
May 1999
April 1999
March 1999
February 1999
January 1999
December 1998
November 1998
October 1998
September 1998


WWW.JISCMAIL.AC.UK

Secured by F-Secure Anti-Virus CataList Email List Search Powered by the LISTSERV Email List Manager