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ACAD-AE-MED  June 2003

ACAD-AE-MED June 2003

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Subject:

Re: Obs Unit

From:

Andrew Hobart <[log in to unmask]>

Reply-To:

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

Date:

Thu, 19 Jun 2003 17:17:08 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (246 lines)

I would have thought that if a patient needs to be admitted to the
"main" hospital wards from an observation ward CDU ward then this is a
ward to ward transfer and nothing to do with A&E waits or trolley waits.
That is assuming that such patients don't return to another part of A&E
prior to admission.
The only time I can envisage this happening is if they "go off" and have
to go to A&E resus. For example a patient with a Head Injury drops their
level of consciousness and is (re)scanned revealing a bleed; they
deteriorate further and need to be intubated for transfer to the
Regional Neurosurgical Unit.
In such as case perhaps we should book them back into A&E as an
unplanned reattendance and aim to get them off to theatre/ ICU/ Transfer
within 4 hours - preferably much less.

Andrew

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Katherine Henderson
Sent: 18 June 2003 22:16
To: [log in to unmask]
Subject: Re: Obs Unit

Dear List - apologies this was indeed a query to Taj who has an
observation
Unit I know. However it may be of interest to others. Taj's example is
exactly what I mean. A patient is admitted to the Obs Unit on  say a
Rule
Out MI pathway needing a late Troponin. Although low risk -or they would
not
have been admitted to Obs, the occasional patient will have a positive
Troponin. As far as we are concerned the clock stopped when they were
admitted to Obs. But if the unexpected happens and it turns out they do
need
admission what do you do? We admit people with gastro-enteritis for
rehydration, little old ladies who have fallen over who need social
services
assessment and a few will also turn out to need admission. These have
come
out of the 4 hour time legitimately. But then what......... On the
computer
system the Obs Unit is  ward - they have to be formally admitted and
discharged including doing a discharge letter for coding. If they need
admission to the main hospital we could either do a ward transfer or
rebook
into A&E - I just wondered what other people do.

Katherine
----- Original Message -----
From: "Taj Hassan" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, June 18, 2003 9:08 AM
Subject: Re: AMI/CHD role


> I may have the wrong end of the stick...but if they
> fail observation ...that means they need in-hospital
> care usually....ie trop +ve....or other pathology
> identified. We admit them to approp team....it is an
> issue in terms of finding a bed etc.
>
> So clock then stops from our view point...is that what
> you wanted to know....probably not?
>
> Other groups either get planned re-attendance...small
> group of ?DVT patients only now...and some pleuritic
> chest pains. Seen in clinic
>
> Some re-attend regularly...DSH.....and some chest
> apins...who either get fedback to GP or to cardiology
> if concerns
>
> hope that helps
>
> Taj
>
> --- Katherine Henderson <[log in to unmask]> wrote:
> > Good to hear from you.
> >
> > Back to the old Observation Unit issue. How do you
> > deal with the time data
> > for patients who 'fail' observation. We have been
> > rebooking them in as
> > planned reviews. this starts them on a new time and
> > got round the concern
> > about unplanned reattendance figures jumping.
> > Afterall while the aim is to
> > get patients home some will not improve as expected.
> >
> > What do you do?????
> >
> >
> > K
> > ----- Original Message -----
> > From: "Taj Hassan" <[log in to unmask]>
> > To: <[log in to unmask]>
> > Sent: Friday, June 06, 2003 11:45 AM
> > Subject: Re: AMI/CHD role
> >
> >
> > > Katherine
> > >
> > > Congratulations on your new post. It sounds as if
> > > common sense will begin to prevail on the more
> > useful
> > > targets.
> > >
> > > I share Bill's concern about more clarity from the
> > > Centre on the disuse of the 20min target. I hope
> > this
> > > will come.
> > >
> > > We have just completed an RCT on the role of a
> > > pre-hospital ECG on the call to needle time. We
> > hope
> > > to present the results at FAEM this year.
> > >
> > > Much can be achieved with this intervention alone
> > and
> > > 'red calling' ahead. I know that there are a
> > number of
> > > systems around the country who are moving towards
> > > pre-hosp thrombolyiss and this may indeed be very
> > > appropriate in the right settings.
> > >
> > > However with appropriate optimisation and Q.A
> > systems
> > > this intervention seems less likely to be useful
> > as
> > > compared to an ECG and rapid transit.....balancing
> > the
> > > risk-to-benefit ratio of thrombolysing in some
> > very
> > > stressful pre-hospital settings a few times a year
> > or
> > > less (average paramedic).
> > >
> > > The crucial message I believe is that EDs must
> > work
> > > closely with their pre-hospital care systems to
> > > eliminate the 'easy' delays. I believe we still
> > have
> > > some way to travel there.
> > >
> > > Thanks for the update
> > > regards
> > >
> > > Taj
> > > Consultant in Emergency Medicine
> > > Leeds
> > > & Acting Head of Service Leicester (for another T
> > > minus 24days :-)
> > >
> > >
> > > --- Katherine Henderson <[log in to unmask]>
> > wrote:
> > > > Dear Emergency Medicine Colleagues,
> > > >
> > > > Some of you may remember that I sent round a
> > mailing
> > > > when I joined the national steering group of the
> > CHD
> > > > Collaborative - the operational spear of the CHD
> > > > NSF. One thing always leads to another and I now
> > sit
> > > > on the Department of Health CHD Taskforce and
> > today
> > > > attended my first steering group meeting of
> > MINAP
> > > > (replacing Roger Evans who previously attended).
> > I
> > > > am the only Emergency Physician on these bodies
> > so
> > > > feel it is important that my colleagues are
> > aware
> > > > that I am there.
> > > >
> > > > Current hot themes are
> > > >
> > > >   a.. The 60 minute target is the one that
> > counts -
> > > > with a 10% improvement in this year on year from
> > a
> > > > base line which will be published with the
> > public
> > > > MINAP report in June.
> > > >   b..
> > > >   c.. A recognition that 20 minutes v 30 minutes
> > > > does not make a huge difference but the 20
> > minute
> > > > target still exists.
> > > >   d..
> > > >   e.. Concern that everyone needs to realise
> > that
> > > > the 60 minute target is only achievable with
> > some
> > > > pretty radical prehospital thinking. All the
> > > > improvements have come so far from the in
> > hospital
> > > > phase. Hence the pre-hospital thrombolysis
> > > > enthusiasm- the only alternative is much shorter
> > pre
> > > > hospital times.
> > > >   f..
> > > >   g.. A unclear commitment to PCI - massive
> > concerns
> > > > about cardiology numbers etc
> > > >   h..
> > > >   i.. A view that ACS patients are really the
> > ones
> > > > we will need to worry about - MINAP is starting
> > to
> > > > get some data but not done anything with it yet.
> > > >
> > > > If anyone at any point wants to raise an issue
> > > > please let me know and I will do my best. I am
> > > > pretty new to this level of discussion and am
> > > > finding my feet. However being a female
> > clinician
> > > > who actually thrombolyses patients regularly
> > does
> > > > give me some unique characteristics and insights
> > in
> > > > the new exiting world of the great and the
> > good!!!!
> > > >
> > > > Dr Katherine Henderson
> > > > Consultant in Emergency Medicine
> > > > Homerton Hospital
> > > > [log in to unmask]
> > > >
> > >
> > >
> > > __________________________________
> > > Do you Yahoo!?
> > > Yahoo! Calendar - Free online calendar with sync
> > to Outlook(TM).
> > > http://calendar.yahoo.com
> > >
>
>
> __________________________________
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>

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