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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