> Another alternative would be to "upskill" the relevant nursing staff > so that they dont call for trivial issues. Perhaps developing some > good protocols for them to manage the common trivial issues and > beefing up indemnity so they are protected if they take decisions > according to these protocols. It is legal worries (often unfounded) > that drive a lot of this stuff
Yes, this is/has been done, but you still get the problem of having some good/upskilled staff and other new/inexperienced/dunny staff, or even some who have some gripe against the GP and take delight in making the GP's life a misery. And then there are a lot of major medical emergencies that can still be handled by a GPassist-type GP ... 1) Anaphylaxis > GPassist orders Adrenaline 1:1000 0.5ml IM (deltoid), hydrocortisone 250mg IV, Promethazine 10 mg IV, O2 @ 4 l/m until stable and sats >95% in air, nursing obs 1/4hourly for 2 hours then hourly to 8 hours. Review by local rural GP in morning before discharge. 2) Acute AMI > GPassist confirms history and acute ECG changes, orders aspirin, morphine IV, heparin 5,000 units IV bolus, saline flush, repalysin 10 units IV over 1-2 mins repeated in 30 minutes, saline flush and continue heparin IV infusion at 10,000units/24 hours. Ring referral (base) hospital to hand over prior to ambulance transfer. All this can be done whilst the local rural GP sleeps undisturbed. The rural GP needs undisturbed sleep - he/she has a full day's work next day and needs to be fully functional and not a sleep-deprived zombie. Probably about 1 in 10 after hours problems would require the attention of the local/rural GP, see page 6: http://www.gpat.com.au/gpat_brochure.pdf John Mac _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
