from an Australian point of view , its the bun fights that's the problem , or the" we will take him if CTPA doesn't show a PE, because then its respiratory " which can leave a patient in ED for a long time
and there is a huge reluctance to let patients go to the ward before they are accepted by a specific speciality.
Last week the urologists would not see a patient with abdo pain post bilateral nephrectomy and cystectomy because as they had removed all organs related to their speciality " its general surgery "
andy stearman
>>> [log in to unmask] 08/30/06 8:03 PM >>>
Mark,
In terms of pt care I would be confident that specialist looking after
specialty stuff is much better,and we can and do refer direct to
specialties........... the difficulty comes when patients are more 'grey
case' or have more than one pathology (how dare they)... in which case a
bun fight ensues in which the pt is merrily bounced from specialty
junior to specialty junior (despite our mantra to our SHOs).
It always amazes me how well specialty juniors (and occasionally
seniors) can manage to invent policy on the hoof.
As a senior I spend a good deal of time refereeing these
matches......... which is not the best use of my time and our money!
If you are going to set up direct referral, which must be in the pts
interest, be very sure to have clear referral pathways or you will be
left in 'Im sorry but we only take calculi in the left kidney and his
pain suggests his stone is on the right side' territory.
(I exaggerate....but only just)
Cheers
Peter
and oh yes and then there's the 'well we would take them but we don't
have any beds'..........arrgggh
>>> [log in to unmask] 07:53 30/08/2006 >>>
I had just this discussion yesterday with our head of clinical
governance.It
has been shown during the emergency services collaborative with
modernisation agency support that ideally cardiology related conditions
should be admitted directly under cardiologists and stroke patients to
go
under stroke specialists.Reducing both morbidity mortality and length
of
stay.
As a geneal theme-patients who are outlieirs on atypical wards have on
average 1 extra day length of stay.
Recent article in EMJ relating to stroke echoes issue of need for
stroke
patients to be under stoke specialists on day of admission.
Mark at macclesfield
>From: John Ryan <[log in to unmask]>
>Reply-To: Accident and Emergency Academic List
<[log in to unmask]>
>To: [log in to unmask]
>Subject: Specialty Specific Referral
>Date: Tue, 29 Aug 2006 18:09:23 +0100
>
>I would be interested to know if any list members practice Specialty
>Specific Referrals from the Emergency Department.
>
>While this is common among surgical referrals eg: fractured ankle to
>orthopaedics, renal colic to urologists, etc it seems less prevalent
among
>medical referrals other than perhaps with cardiology. It seems that
the
>most common pathway is for a patient being admitted with, say,
jaundice to
>be admitted under the 'on-call' or take physician even if that is a
>rheumatologist or a respiratory physician.
>
>Clearly this may not be possible in smaller DGHs but it may be more
>possible in larger university hospitals with greater numbers of
physicians.
>
>When I worked in Australia we had specialty specific referral and we
woudl
>call for example the endocrinology registrar during the day or the
>consultant endocrinologist at night (though the patient would be
'babysat'
>by an on-call registrar out of hours.) for a diabetic emergency
requiring
>admission.
>
>Has anyone implemented this system ? There is a suggestion that it
could
>lead to a decrease in Length of Stay for patients (you know, avoiding
that
>3 day time delay while a consult slip gets passed between firms).
This
>would bring about a virtual increase in the bed pool which would in
turn
>decrease trolly times (for those of you not working within England's 4
hour
>target)
>
>Does it make a difference where you work ?
>
>John Ryan
>
>
>
>
>
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