Comments on Dr Rant: 3:38 from Idiot Central

this, fox, is the link, I'm going to quote from it...

2008-03-17T17:56:00.000Z

this, fox, is the link, I'm going to quote from it to illustrate a & e cn's points

http://news.bbc.co.uk/1/hi/health/1574652.stm

"Mr Rogers, 74, died after he was left for nearly nine hours on a trolley at the Accident and Emergency Department of Whipps Cross University Hospital, in Leytonstone, east London."

and

"His condition was assessed by a triage nurse who decided he should be seen by a doctor within one hour.

However, a doctor had still not seen him at the time of his death."

and

"The official report of the inquiry team says that Mr Rogers' long wait was not unusual for patients at Whipps Cross."

and

"The report says that it was probably not obvious that Mr Rogers had suffered a ruptured aneurysm."

and

"However, it says that if he had been seen earlier by a doctor, and the diagnosis made, it is possible that he might have survived.

The nurse who initially assessed Mr Rogers prioritised him correctly, the report says, but heavy demand from other patients made it impossible for him to be seen within one hour.

Given this, Mr Rogers should have been re-assessed, but this secondary assessment appeared not to take place. "

Dear A and E charge nurse,I am sure that you have ...

2008-03-15T19:11:00.000Z

Dear A and E charge nurse,

I am sure that you have excellent inpatient experience, but is that experience from before the 4 hour target time or have you seen the effects on MAU/SAU? Things have changed and not for the better.

If a Nurse sees a patient, "correctly" triages them then they have to wait a few hours before the Dr can see them then surely the nurse has a responsibility to check back on them from time to time?

Of course now the Nurse would now have the ability to discharge "correctly" triaged patients from the dept to meet a target, so instead of waiting a few hours they do not see the Dr at all. But that is a seperate issue...

The other noticeable effect of the 4 Hour wait is to slow down the productivity of both nursing and medical staff, by getting them to spend loads of time completing EDIS rather than actually see patients.

Its this sort of Bollocks that caused my wife (former Staff Nurse in Casualty) to quit NHS nursing.

It might suprise you fox in the sox but the patien...

2008-03-14T22:06:00.000Z

It might suprise you fox in the sox but the patient was correctly triaged, at least according to the inquiry chair, Dr Ruth Brown, consultant in emergency medicine - ideally the patient should have been seen within an hour after this assessment.
http://news.bbc.co.uk/1/hi/health/1574652.stm

Are you suggesting that a nurse (or the C/N)should have made the diagnosis of AAA clinically, without the aid of x/ray, ultrasound, or C/T ?

I daresay there are one or two experienced A&E nurses who might have suspected this condition, but surely we are straying into very dangerous territory if thousands of patients have to rely on a nurse because they must expect to wait for many hours before being properly examined by a doctor.

It is also unfair to suggest that I cannot see things from an in-patient perspective - you can't just walk into an A&E nursing post without having done your stint on the wards first.

I am not a fan of managers.
I am not a fan of clocks.
But in my humble opinion clinical standards in A&E (overall) are probably better than say 10yrs ago, notwithstanding a certian % of gaming and hurried care.

Can I make a suggestion ?
EVERY time care is compromised in A&E (because of the target) ask your juniors to religiously complete clinical incident forms - I'll bet that within a few weeks steps wil be taken to try to improve things.