> In these days of limited bed capacity
> and tighter targets, why not simply get your scan during
> their first attendance, and then discharge them? Basically, I
> very rarely admit someone for a scan these days. It seems a
> rather outmoded way of doing things. If someone needs a scan
> urgently, then I scan them...immediately. If they need a scan
> non-urgently, then they get it as an outpatient. Admitting
> them for a scan seems simply like a way of temporising so
> that the radiologist doesn't have to get of his a****.
Interesting way of doing it. Certainly seems to make sense from the point of
view of the patient and cost effectiveness. The Scottish figures when they
were looking at cost effectiveness of CT scan for stroke put the cost of an
out of hours CT at between £55 and £173 (big local differences); but this
was total cost rather than additional cost for scanning at night instead of
during the day. Cost of a hospital bed is about £200 a night. There seems to
be a reasonable amount of money wasted doing a botch job of various things
in A and E rather than either A and E doing them properly or another
speciality providing a 24/ 365 service. Other examples include trying to
provide an emergency cardiac service without echos and a soft tissue service
without MRI or ultrasound in many places. We have a similar problem with
DVTs in my own unit- check d-dimers; if positive start on fractionated
heparin as an outpatient then get an outpatient ultrasound a few days later.
Ought to be cheaper (and better for the patient) to have ultrasound or
plethysmography at point of initial attendance.
I'd guess that with the CTs you could probably cut your cost a bit further
by having a preliminary report by your consultant or middle grade at the
time (should pick up anything needing a neurosurgeon that day) with a formal
radiologist report next working day and telephone referral to the
appropriate place if needed.
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