Here we go again…
There is a story in the news, this time from Australia, about charging patients who “shouldn’t be in the emergency department”. Here’s someone tweeting about it:
The Sydney Morning Herald reports:
…state-run hospitals will be given the power to impose a fee of about $7 to stem a potential rush of patients from GP clinics to free public hospital emergency rooms.
I regularly have to look at CVs for new doctors looking to work in the hospital. In many of them, the candidates point out that they are “proficient in Microsoft Word, Excel and Powerpoint.”
Well done! That’s great! However, in this day and age, claiming in a CV that you can use Microsoft Office is equivalent to saying you can set a video recorder. There was a time when it was impressive, it’s not impressive anymore.
It has been an interesting few days as the hospital I work in has been in the news for overcrowding. There sometimes feels like there’s a disconnect between overcrowding and patient safety. On one hand, the international evidence repeatedly shows that ED overcrowding has a negative effect on patient outcome, with increased morbidity and mortality. On the other hand, we are all working in busy EDs, and many patients are getting timely, appropriate care from hard-working staff in spite of these pressures. We are hanging on, doing our best, etc, etc.
The disconnect is because while overcrowding does increase patient risk, it doesn’t change the outcome for every patient. The best way to explain this is by the speed limit analogy.
Since I started this blog a few weeks ago, I’ve tried to write a piece about the so-called “inappropriate attenders” that turn up in A&Es all over Ireland & the UK. If the politicians are to believed, they are ruining everything for everyone.
I think “inappropriate attenders” is another one of those phrases like “admission avoidance” which are weighted with an odd kind of patient-blame. Anyway, I was trying to write something but Dr Malcolm McKenzie (@fourhourtarget) managed to say most of what was on my mind in his recent blog post.
I wanted to add three things:
Earlier today, IEMTA, the Irish Emergency Medicine Trainees’ Association were in the news for a letter they sent to Irish statutory body HIQA ( the Health Information and Quality Authority) highlighting the dangerous level of overcrowding that’s currently happening in Irish EDs. You can read about it here.
It was the lead item on the national lunchtime news here. Some thoughts…
The Admissions Myth
When is an admission an admission?
24 hours a day, 7 days a week, 365 days a year, people come to emergency departments. They come by car, by foot, by ambulance, by helicopter looking for care in the hospital. Yet they are not “admissions”, they are “attendances”.
The majority of these patients have all their care done in the ED and are sent home. A minority, let’s say a third, need to be referred and seen by a second specialist team who will decide invariably to keep the patient in hospital. At this point they become an admission.
It’s the same patient, the same person, but by a simple decision they cross the Rubicon from attendance to admission. This is weighted with significance, and I think it’s wrong.