Causality Doctor

Interesting letter from Colm Henry @HSELive to @AssocEmergMedIE . If patient in the emergency department who could and should be seen by acute medicine responsibility lies with emergency medicine(EM). So we are now openly saying if system dysfunctional all risk remains with EM?

Imagine working in an emergency department where 66% of your working week is without other services available (outside 8-4) and crowding levels are such that many patients presenting in office hours are seen much much later removing all options for safe discharge.

Over 1,500,000 patients go through emergency departments in this country per year. Well over 1,000,000 are discharged directly with no in patient service input. Few if any are inappropriate (or soft as you mentioned earlier). It is NOT a TRIAGE system.

Really important message from Bernard Gloster. The system @HSELive is focused on and reacting to the care of in-patients . . . . unless they are in an emergency department waiting admission or waiting to be seen and harm befalls them as a result of crowding.

Jones et al excluded patients in three emergency department over 12 hours as they felt this was unreasonable and not likely to happen. This study as good as it is excludes patients in the emergency department more than 48 hours. Not uncommon and should be interrogated further.

Have to say I really miss this page. The fellowship (FUCEM) and the conference of waiting room medicine. I continue in my role of apologizing for “waiting medicine” @AssocEmergMedIE @HSELive

Interesting Adrian Boyle @RCEMpresident highlighting the obvious need for services to provide care for THEIR patients and stop dumping to emergency department. The speciality reply noting their assessment spaces are full fails to see that the ED spaces also full. Hence this . .

@RCEMpresident @RCEMevents What do you think of the new Irish guidelines for cauda equine.

New neurology more than two weeks duration now solely the remit of emergency medicine through review clinics.. Involve orthopaedics only when necessary.

But remember they now include unilateral radicular pain so number of presentations are going to go up significantly. Now the responsibility of ED to sort out radicular pain.

Assess for red flags