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ACAD-AE-MED  February 2010

ACAD-AE-MED February 2010

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Subject:

Re: Use of the resus room and consultant call in criteria

From:

Rowley <[log in to unmask]>

Reply-To:

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

Date:

Mon, 8 Feb 2010 11:05:44 -0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (90 lines)

Crumbs. We'd never go home. Have you audited how many of these calls result
in a Consultant attending the department?

I noted from another correspondent the suggestion that a valid reason for
calling the trauma team was "because the ambulance service asked for it."
Can I suggest that this isn't a good idea? Calling a trauma team should not
be seen as a trivial exercise. Firstly, it creates a great deal of
disruption elsewhere in the hospital. The members of a trauma team are not
standing like guardsmen in sentry boxes awaiting the call, they are busy
with their own work. Secondly, it sets a burden on individual paramedics. We
don't tell an ambulance service which resources to deploy to an incident
because we don't know what they have available and how it is to be used -
and the corollary is that the service don't know our resources and their
availability either. An entire hospital can find its operations disrupted
for some hours at the whim of a gung-ho paramedic. We withdrew it from our
call-out criteria.

-----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: 08 February 2010 09:37
To: [log in to unmask]
Subject: Re: Use of the resus room and consultant call in criteria

Our criteria for calling the consultant at night are:

Patients with pulse rate < 50 or > 110 unless well or stable arrythmia
Systolic BP < 100 Respiratory rate over 30 Oxygen Saturation < 85%
Responsive only to painful stimuli (or GCS < 13) All patients admitted to
the resus room with:
. Airway problem, respiratory failure or shock not responding to simple
measures . Trauma (major or multiple) . Seriously ill or injured children .
Patients likely to require Intensive Care . Diagnostic or therapeutic
uncertainty . "VIPs"  & patients in resus longer than 2 hours Clinical or
administrative problems that cannot be resolved by the duty middle grade
doctor or senior nurse.

In particular, a consultant must be called for any critically ill patient
including but not confined to:
. Patients with systolic blood pressure < 100 mm Hg, . Respiratory rate over
30, . Glasgow Coma Score < 13 . Acute confusional state especially
associated with pyrexia) . Acute severe asthma with PEFR < 33% predicted or
failure to respond to nebulisers . Patients post resuscitation . Any patient
who appears shocked 


I'd thought I'd had something about certain drugs in there, but looking
through current guidelines I don't, so must have dropped it a few years
back. Certainly used to have rules that you called a consultant if you were
using inotropes, aminophylline or doxapram (might have been a couple of
others in there as well). The idea is drugs that are either a bit dodgy on
the risk: benefit ratio or whose use implies the patient is pretty sick.

Seems to work pretty well. Brought it in over 10 years ago now. When it
started I got a lot of calls saying "I didn't want to call you but the rules
said I had to", most of which turned out to be cases where I needed to be
there. The biggest problem is not failure to treat critically ill patients
correctly but failure to recognise that they are ill so you need something
that overrides a judgement of "this patient looks pretty OK: refer on and
forget about them".

There is some debate about what to do about waiting times: consultant call
for waits above a certain time; for waits in majors above a certain time;
whatever. Currently don't have that. Thinking about having the consultant
come in whenever cubicles get too full to decide who can wait in the
corridor/ "transitional ward area".

Matt Dunn
Warwick




Did you know South Warwickshire General Hospitals NHS Trust is applying to
become an NHS Foundation Trust? You can find out more about our application
and/or apply for Membership at
http://www.warwickhospital.nhs.uk/foundationtrust/default.aspx or by calling
our Foundation Trust Office on free phone 0800 085 2471.


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