It wasn't really picked as a throwaway line, but I take the point that
burst speed is not sustainable. Certainly in optimum conditions it is
easily possible, but I concede that a couple of mysterious indigestions,
a suicidal and a collapse ?cause can bog me down.
I am most emphatically NOT trying to spark a doctors v nurses row - I
want to move us on from an anachronistic attitude and approach which is
The point I am making is that we seem to collectively have a complete
group of staff missing. They are the people to do the unglamorous jobs.
A department needs someone going round restocking, cleaning and tidying.
We need someone to ensure that patients are called in and sat or laid
down as appropriate to be examined. Gofers. Roadies. Once upon a time
nurses did it, but as their numbers decreased and their skills,
education and training increased (pace Robin, of course empowering
nurses and improving their education has been beneficial) they have
neither had the resources nor inclination to do these so-called menial
tasks. We desperately need someone between the cleaners and the nurses.
> *From:* Paul Bailey <[log in to unmask]>
> *To:* [log in to unmask]
> *Date:* Tue, 15 Aug 2006 01:16:24 +0800
> 20 patients per hour is an easy throw away line that is not likely to
> be tested. The simple truth is that if one bottleneck in the system
> removed - eg the unlikely event that a doctor is able to see 20
> patients per
> hour - other bottlenecks will be revealed eg access to radiology,
> ability of
> clerical staff to generate paperwork etc.
> Whilst it may be possible to physically see 20 patients per hour, I
> * this is possible for anything but the most 'minor' complaints
> (should they
> be in an ED in the first place?)
> * this is possible to do across a whole shift - eg 180 patients in a
> * it is possible to practice high quality medicine in this manner - eg
> documentation, vigilance for low frequency / high morbidity conditions
> The US system is probably the best system to use for reference. They
> set up so that the high cost individual (the doctor) has unimpeded
> access to
> patients. In this system, the usual across all shifts patient
> activity is
> around 3.5 pph.
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Dunn Matthew Dr.
> (RJC) A &
> E - SwarkHosp-TR
> Sent: Monday, 14 August 2006 5:26 PM
> To: [log in to unmask]
> Subject: Re: 20 patients an hour, easily[Scanned]
> Don't know about Dr Cottingham, but the rate is achievable. I do from
> to time go at that rate or higher myself, although in a relatively
> department it is unusual to have 20 patient present at a time. It
> does rely
> on having the patients present in the cubicles when you arrive;
> already on a
> trolley if they are slow at getting on a trolley and with the
> body part exposed. The way to combine it with teaching is to go in
> with the
> F2, see the patient and tell them what to write while they write up
> notes. Or alternatively swap roles. The two doctor idea was one I came
> across as an experiment in Stoke while I was a registrar- either Tony
> Redmond's or Mark Prescott's idea, I think. I was initially sceptical
> efficiency but in fact the talking/ examining and writing take about
> same length of time. What struck me was that whether I was in with a
> of the same, higher or lower grade and whether I was the examining or
> writing doctor it worked as a learning experience.
> Outside Emergency Medicine, things have changed but when I worked in
> Practice (in the days when no evidence of being adequately qualified
> to do
> so as a locum was needed) it was not uncommon to have 3 minute
> > "I could easily see 20 patients
> > an hour and teach an F2 in minors in such a system."
> > I challenge Dr Cottingham to do this.
> Matt Dunn
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