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ACAD-AE-MED  November 2002

ACAD-AE-MED November 2002

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Subject:

Re: Waiting in EDs

From:

[log in to unmask]

Reply-To:

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

Date:

Thu, 28 Nov 2002 17:31:20 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (45 lines)

Gloria Gaynor

        -----Original Message-----
        From:   p=NHS NATIONAL INT;a=NHS;c=GB;dda:RFC-822=ACAD-AE-MED(a)JISCMAIL.AC.UK;
        Sent:   Thursday, November 28, 2002 10:12 AM
        To:     p=NHS NATIONAL INT;a=NHS;c=GB;dda:RFC-822=ACAD-AE-MED(a)JISCMAIL.AC.UK;
        Subject:        Re: Waiting in EDs

        >
        > Hang on a minute Steve, I could understand this if my docs were sitting
        > at
        > the waiting room door, champing at the bit, waiting for the patient to
        > emerge from the triage room. But it doesn't seem to be that way 'round
        > these
        > parts. The patient goes through the triage process and, including
        > registration, triage and various initial obs and tests, they "emerge"
        > to sit
        > in the waiting room at the 20 to 40 minute mark. They then wait for
        > another
        > 2 to 4 hours before being entertained by one of the cas docs! I cannot
        > therefore see how triage is "monolithically" holding us back!

        That's easy. Triage, if you cast your mind back, was introduced to stop people collapsing unnoticed in the waiting room. It rapidly
        acquired a life of its own, to the point where three years ago or so, if the waiting room was empty, the nurse would insist on going
        and seeing the patient first! It does act as a brake for the simple reason that the nurse was not empowered to discharge, even if it
        was a cut finger unless he or she was an ENP, and as they were and still are a scarce resource too that was rare. So the waiting
        room would simply fill with people, up to 40% of whom could have simply gone home. However, they would then see an SHO
        (even now, far too much of our service is delivered by terribly inexperienced junior doctors) who would not have the experience to
        turn them straight around and out and so more tests would be done and waited for.

        As I said a week or two back, the critical change in the pathway is the Diana Ross bit:

        "Go on now, go walk out the door
        Just turn around now
        'Coz you're not welcome anymore"

        Well, perhaps not the last line (!)

        Best wishes,


        Rowley Cottingham

        [log in to unmask]
        http://www.emergencyunit.com

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