Friday, 28 November 2014
The author of in stitches reflecting on the crisis
Commentary from Dr Nick Edwards on life in the current A&E crisis
Wednesday, 26 November 2014
Joint clinical handover
Clinical handover between staff is a constant staple of our professional lives.
The quality of that handover, and critically the information that is imparted, is key to the patients remaining care in the Emergency Department. If the correct information is handed over then good quality care will continue for the
remainder of he patients four hour stay.
The inter-shift handover is probably the most important of the day for all clinical staff, where not only are the patients currently in the department
handed over, but other key issues such as estate problems, outstanding requests, and pathway or process issues are as well. There has been significant writing in the nursing press about inter-shift handovers on the ward area, with a lot of focus on its location, normally either at the bed side or in the ward office, but little has focused on the ED, and our environment is not the same.
Being one of the few areas of the hospital that truly works together with our medial colleagues twenty four hours a day brings about its own unique handover requirements. For example issues with process or estates are as
relevant to the medical team in the emergency department as they are to the
nursing staff.
Some individuals will argue that there are specific nursing issues that require
a separate handover. However in the Emergency Department the nursing
assessment is just as relevant to the medical staff as the medical plan of
treatment is for the nursing staff. The most obvious way to handover information that is relevant to both professional groups is through a joint clinical handover. By undertaking a joint
handover at the start of shift, everyone who is starting can hear the same clinical details. There is the opportunity for learning as the junior doctor presents their patients to the consultant at the handover, whilst patients who are waiting to be seen are presented by the nursing staff.
From a senior management perspective it is useful to have all the nursing and
medical staff in one place. Key issues effecting the department can then be
handed over to everyone at the same time. It allows consultant engagement
with the nursing workforce, and senior nursing engagement with the medical
workforce, producing a cross pollination of learning. In this way problems or jobs in the department do not become labelled as “nursing” or “medical”, they
becomes issues for the department, that all are involved in addressing.
The key to undertaking a joint clinical handover is the structure that you use.
Without structure to the handover different professional interests and issues
arise and any focus and benefit to the handover is lost. A large space without
interruptions is also useful, either at the back of the clinical area, or in a training room.
One of the benefits of undertaking this handover in an administrative or other
quite area is the potential to turn it into a power point presentation, and this can help to ensure that everyone follows the standard format during every handover. With a power point presentation it also allows flexibility for the senior management team to add key current issues to the presentation. This allows them to impart key current information that is topical for that week to all the staff, as individual emails are sometimes poorly read.
Political debate increases
Whilst this blog remains politically neutral, it is interesting to see the episode regarding the Secretary of State for health continued this morning following his appearance on BBC breakfast.
He is right there is a delay to accessing primary care services at the weekend, and it is far easier to visit A&E, even if that is not what the official advice is. The response is that GP's should be open at weekends.
We should recognise that having GPs open at weekends will probably not significantly change the number of patients in A&E, what you need is a change in the carrot.
If I believe as a patient that I have an emergency, or want an instant answer to my health problem at a point convenient to me then I will go to A&E. I will not want an appointment in the afternoon, I will probably have other things I want to do then.
The only apparent way to fix this is to turn the GP surgery into an open walk in access, or relocate them into A&E and let the triage nurse feed their patient list.
We have tried over many years to educate people on which point to access the nhs, however this has been without success, everyone knows A&E is open though, maybe we should stop trying to create other access points to the system and properly resource trg one that everyone uses.
Here is the original BBC article:
Tuesday, 25 November 2014
Country wide black alert
Significant amount of trusts across the country declare black status: beds in the hospital full, patients boarding in A&E
The problems A&E faces
This is an interesting post quoting the Secretary of State for health. If he is unable to correctly access GP services as someone who is more than aware of the choices and routes available then how can we expect members of the public to do so.
Maybe we should stop trying to convince people not to attend A&E and instead put the GP there as well
Sunday, 23 November 2014
Investigation reaches the national press
The north west London investigation into a&e closures reaches the national press
Saturday, 22 November 2014
Failure to hit the standard, the political side
In yet more news politicians discuss the failure of the A&E's to hit the 95% target.
Friday, 21 November 2014
Independent investigation
So there is going to be an independent investigation into the closure of two a&e departments and if this has had any impact on the other nearby units.
It will be interesting to read the report, as whilst there has been a decrease in performance, this has been observed nationally. We will have to wait and see if direct links can be made between the closure and loss of performance.
Wednesday, 19 November 2014
ED in the news
Never far from the news, the constant buzz of ED, described by some as the pressure valve of the healthcare system. Here is a local paper article about ED issues at James Cook hospital:
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