Broadly agree that many attenders at A+E could be managed by GPs
But when are we going to get rid of this category 4 and 5 classification
that is forever used? It is a classification of URGENCY which has almost
nothing to do with who is best to manage the patient in category 4 and 5
. OK I accept that in category 1-3 it may be valid in many cases.
There are a few other issues.
Why cant nurses deal with some of these patients? I suspect the
medicolegal issues are no worse than with inexperienced residents (an
experienced A+E nurse is probably *much* better at assessing these
patients.) The aim should be to deal definitively with these patients
where possible, which should be feasible face to face. It should not be
to push them to another part of the health system such as to GPs. Any
medicolegal risk can be borne by the govt in any case
Why do we worry about waiting time at all? IMHO it is not a valid
indicator of quality except in the truly urgent conditions . Of course
there is political pressure in media etc. It is not an economical use of
resources to schedule enough staff so that all and sundry can be seen at
any hour that they breeze in within a certain timeframe
Some people dont want to be visible on the Medicare radar for various
reasons so they go to A+E routinely for their medical care. Solution? I
dont think it is a large issue
Cost is a significant issue - solution - charge a copayment in A+E. If
you cant stomach the politics of that, do it for noncard holders. I
suspect that would have some impact
An open access clinic within 1-2 days like a trauma clinic for various
specialities such as general medicine, geriatrics, mental health and
general surgery would head off a lot of A+E admissions. There is no
alternative apart from A+E to an outpatient appointment, which may be
months away.
R
Alexander Bennett wrote:
On 16/04/2006, at 12:01 PM, Ian Haywood wrote:
Oliver Frank wrote:
are probably intended by their funders to provide mainly secondary
care,
do also provide primary care by allowing anybody to walk in to their
emergency departments and be seen for problems that could have been
treated often better and usually much more cheaply in primary care
settings such as general practice.
No,
The funders (especially the Feds) insist, by legislation, that any
H. sapiens who
presents at an ED must be seen by a doctor, no matter how trivial
Triage nurses can triage, but
cannot send a patient away, ever. The hospitals would love to change
this rule.
Generally the numbers of ED presentations who really could be
managed in [urban] GP is barely 10%
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