Having had the proposal last year that A&E consultants should q bust any
time it suits the managers- I indicated that when there is a waiting list Q
that needs busting they pay surgeons and anaesthetists extra.If the bottle
neck in A&E is due to lack of medical beds and inefficient consultant
physician practices then perhaps the consultant physicians (all 11 of them)
would consider working partial shift at the weekend (as the 2.6wte) do, and
consider proactively seeing patients (as we do) and not wait for the
traditonal hierarchical approach to kick in.
I also showed them the BAEM guidance that indicates we are not employed to Q
bust minors out of hours.That all said I do think some traditional AE
practice of reactive office based care does not help thos of us reformed to
a proactive approach.
mark in macclesfield

>From: Ray <[log in to unmask]>
>Reply-To: Accident and Emergency Academic List <[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: Four hour waits and on-call
>Date: Fri, 17 Dec 2004 21:42:49 -0000
>
>The Sheffield Research Group sent me a letter questioning  why there is a
>peak of people being discharged in the A&E departments in England between
>around 220 and 239 minutes just prior to the 4hr target. It doesn't happen
>in Lancaster!  I suspect it is patients being quickly pushed around to
>Observation Wards and Clinical Decision Units. What do people think?
>
>I've heard of another way of getting around the target. One department
>doesn't start the clock until the patient has been triaged by a nurse. So
>the rate limiting flow of patients into the department is the Triage Nurse.
>
>Now that said the 4 hr target has improved the situation in many A&E
>departments by increasing resources and getting the rest of the hospital
>engaged with the problem..... so let's not be too negative.
>
>I think the problem is the target is set too high. In times of peak demand
>(in the summer for Lancaster) the target won't be sustained unless patients
>are diverted away to the GP or told to come back later. As we are an open
>access service i.e. we don't give appointments like our local out of hours
>GP service... it's bound to cause problems with a 98% target.
>
>By the way..... one Consultant I met at the Faculty meeting was impressed
>that I was still in the department so late at night. Well I'm not ...... I
>do this E mail writing from home! I'm busy seeing patients at work.
>
>Ray McGlone
>Lancaster
>   ----- Original Message -----
>   From: Adrian Fogarty
>   To: [log in to unmask]
>   Sent: Wednesday, December 15, 2004 8:15 PM
>   Subject: Re: Four hour waits and on-call
>
>
>   My colleagues and I specifically excluded "nocturnal queue busting" when
>we negotiated our contract earlier this year (although I'm happy to do some
>queue busting when I'm on my shift). We might have considered it had our
>managers offered us a more favourable deal at the time, but they didn't so
>we didn't. But even if they had offered us a better deal, I think I'd
>prefer the easier option and just forget the money, thank you very much,
>particularly considering BAEM's stance on the matter, and also considering
>that I might have to stick at this game for another 20 years!
>
>   Our trust did have the irritating habit of "escalating" up to us when
>breaches were imminent, which I found intensely irritating, so they've now
>put a stop to that as well (it was a pointless "escalation" as there was
>nothing I could do in the vast majority of cases). My words were along the
>lines, "if they want someone to mop up queues of minors on a Saturday
>night, then a consultant is not who they should be looking for".
>
>   I agree with Sue, we mustn't lose sight of the fact that this target is
>arbitrary and politically motivated, notwithstanding the benefits it has
>brought to our services over the last two years. We must use the targets to
>continue to improve our services, however, but not let them ruin our lives.
>
>   Adrian Fogarty
>
>
>   Simon McCormick <[log in to unmask]> wrote:
>     Folks,
>
>     Is anyone else being pressured to come in to stop breaches whilst they
>are
>     on-call? This is specifically because patients have waited about 3
>hours to
>     see an A&E doctor and are likely to breach because of this wait to see
>a
>     clinician in A&E. I'm on-call for the next four days and know that the
>     on-site manager has been told to phone the A&E consultant if breaches
>due to
>     wait to see an A&E doctor are 'likely' to happen.
>
>     Simon McCormick