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ACAD-AE-MED  May 2005

ACAD-AE-MED May 2005

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Subject:

Re: Multiple clerkings

From:

Rowley Cottingham <[log in to unmask]>

Reply-To:

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

Date:

Tue, 3 May 2005 19:51:26 +0100

Content-Type:

multipart/mixed

Parts/Attachments:

Parts/Attachments

text/plain (155 lines) , PAT template.doc (155 lines)

What an extraordinary response! I have been contacted by literally dozens of
people wanting a copy of the template, so I feel quite justified in posting
it to the list. It is appended to this posting.

There are a couple of things worth knowing. 

1. Get your physician and surgeon colleagues on board. Their juniors WILL
grumble that suddenly they are doing their own work, not just clerking, but
chasing bloods, etc. The orthopaedic juniors have looked astonished to see
on my PAT sheets only the words, "Clinically #NOF. X-ray confirms.
Analgesia, refer ortho". I'm not going to ask about drugs, social features
and so on. Why should I do the junior's work?

2. For the same reason, pilot it with Consultants seeing patients. They are
already experienced at rapid assessment and disposal; the template merely
acts as a note pad.

3. The template is deliberately designed not to resemble a clerking. It also
follows a logical sequence already familiar to ED staff; the ABC of ATLS.
Notes in the margin act as reminders to the juniors on how to fill it in -
and are also visible to other juniors planning to argue.

4. The person using the PAT template should set a short period of time to
decide - I try and make a decision in 7 minutes - often much less. If a
patient with chronic lung disease has a pCO2 of 8.5 they aren't going home
tonight, are they? Immediate medical referral - but supportive and
resuscitative treatment must be put in place. If it sounds as though the
patient is going to take a while to untangle hand it over to an ED SHO to
clerk and finish and report back to you.

5. The PAT template works really well with a CDU; you can do a rapid
intervention such as nebulising an asthmatic or await some results to see if
the patient can go home later.

6. Problems we encountered included finding time to so it when there are
lots of other calls on Consultant time (we try and get the middle grades
PATTING during the day, and the Consultants do the 17:00 to 21:00 shift) and
PATTING when the department is busy with sick patients who take Consultant
expertise to sort.

I'd be very interested in people's thoughts and feedback. The format is only
a suggestion and has gone through a couple of iterations since invention.
Print it out on either side of a single sheet.


Best wishes


Rowley.



-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Simon Odum
Sent: 01 May 2005 22:08
To: [log in to unmask]
Subject: Re: Multiple clerkings


And me too please!

Simon Odum

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of fred thompson
Sent: 01 May 2005 20:25
To: [log in to unmask]
Subject: Re: Multiple clerkings


Could I also have a copy

Ta
Fred
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Sarah
Sent: 01 May 2005 20:22
To: [log in to unmask]
Subject: Re: Multiple clerkings

Could I have one of those templates please?  Many thanks...

Sarah

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
Sent: 29 April 2005 20:48
To: [log in to unmask]
Subject: Re: Multiple clerkings

The answer is not to clerk in the ED. We have pioneered the PAT approach;
the primary assessment team. The idea behind this is that the patient is
assessed by a senior doctor and nurse. The paperwork looks nothing like a
clerking - deliberately. We do enough to make a decision - obvious admission
(fine, resuscitate, off to medical assessment unit as soon as safe) or needs
bloods to decide. This second group are passed to an SHO to clerk and
probably go to the CDU to await results. The SHO can then update the senior
doctor with the full clerking to facilitate decision making. The target time
for PAT is 7 minutes, and it happens at entry. Currently we run this from
8am to 9pm. Works for us, although there are certainly other approaches that
achieve the same end.

I'll happily forward a copy of the latest version of the template to anyone
interested rather than clogging up the list.

Best wishes


Rowley.



-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Sunil Dasan
Sent: 29 April 2005 11:21
To: [log in to unmask]
Subject: Multiple clerkings


Does anyone on the list know of any documentation which is used for all
emergency attendees (ED and other emergency units) and then carried on by
inpatient teams if they are admitted?

We are having a bit of a problem with patients having the same histories
documented time and time again by nurses, A&E docs and inpatient docs
amongst others.

I'm happy to be contacted off-list

Sunil


http://www.surreyandsussex.nhs.uk

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