We do much more diagnostic and initial management than in the old days. "In my day" - the A and E department concerned itself with trauma, major and minor, and triaged all but the most severely sick medical cases. In that situation, 4 hours seems pretty reasonable.
I feel an inner certainty that Sir Humphrey and his tame MPs don't know it's all changed and its we that do the interesting stuff now.
This is a fundamental misunderstanding. The change was gradual and obviously imperceptible.
Alan
--- On Fri, 20/3/09, Rowley Cottingham <[log in to unmask]> wrote:
> From: Rowley Cottingham <[log in to unmask]>
> Subject: Re: Stafford Hospital
> To: [log in to unmask]
> Date: Friday, 20 March, 2009, 10:11 AM
> The 4 hour STANDARD (we aren't allowed to call it a
> target any more) was
> intended to be measured in our departments to drive up
> improvements
> elsewhere in the system. The problem is that it worked for
> a while to
> improve systems and processes; reducing and regularising
> bed stays,
> improving community services and so on. The problems are
> starting to
> reappear within emergency departments because it was seen
> as a single
> shot solution. It was, in as much as an efficiency saving
> only works once
> for a given number of episodes.
>
> What the policy did not take into account was that patients
> would fail to
> keep their part of the bargain and didn't stop coming
> to EDs. Indeed,
> they have been cheeky enough to flood in in ever greater
> numbers - our
> admissions continue to rise inexorably and I doubt we are
> unique. There
> has not been a concomitant expansion in bed numbers to cope
> with this,
> meaning that the pressure falls back in the only department
> in the
> hospital with elastic walls.
>
> The solution then is to review bed numbers or require
> further 'efficiency
> savings' in bed stays or community solutions in the
> light of these
> changes in admission, not to cane EDs ever harder while
> ignoring
> everywhere else. I doubt community solutions are the answer
> as the acuity
> of those arriving seems as bad as ever, and maybe worse
> than before.
>
> It really isn't our problem, and I detect considerable
> frustration from
> colleagues who rightly feel aggrieved that it has been made
> ours. Again.
>
> /Rowley./
>
> > *From:* "McCormick Simon Dr, Consultant,
> A&E"
> > <[log in to unmask]>
> > *To:* [log in to unmask]
> > *Date:* Fri, 20 Mar 2009 09:42:03 -0000
> >
> > Should we be reducing the target to 95% or improving
> the systems to
> > ensure it gets met?
> >
> > My department sees just over 200 patients a day and
> I'm not
> > convinced there are 4 patients a day who NEED to be in
> the ED for
> > more than four hours so 98% could be considered
> reasonable. If the
> > standard was dropped to 95% then I'm sure I would
> feel a little
> > less stressed for a while (and like many of you I
> guess, that would
> > be gratefully received) but the problem of bed waits,
> delays for
> > specialties to see patients, transport problems etc
> would still
> > exist but there would be less incentive for the Trust
> to try and do
> > something about them.
> >
> > The big problem of course is investment and whether
> pushing the
> > four hour standard gives value for money... probably
> not. That is
> > why it isn't invested in and why so many of us are
> forced to work
> > round it and concentrate on quantity rather than
> quality.
> >
> > Simon
> >
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