Statistics from Altmetric.com
Thank you for the replies to last month's in tray. Further feedback is given in emjonline (www.emjonline/contents/SIMS3).
The strategic reports were very interesting and many had similar ideas to Dr York's own analysis (detailed feedback on internet). Some of you suggested that the report should be shared with the chief executive. This is a high risk strategy but with a possibility of gaining influence in high places. Most of you identified the accident and emergency (A&E) staff as key stakeholders and suggested a “time out” with the staff. This was successful and a brief report of this meeting is appended. Unfortunately Sister Oak was on annual leave and Mr London did not come as it was his half day (file note of this meeting on the internet). The next stage is to formulate a project plan for the major objectives. Aspiration is easy, realisation is difficult.Emerg Med J 2001;18:283–284
The complainant is still very unhappy and is asking for an independent review. Her letter and the response are on the internet. This complaint is not going well and we will take a “time out” to examine the reasons and see if lessons can be learned.
Some of you acted on the results that were in the first “in tray” but many did not. A letter from a solicitor has arrived and likely to result in a claim for damages.
Letter has arrived from Sister Oak who has seen a copy of your strategy and is not happy with some aspects of it and is also unhappy she was not consulted.
Your report has also ruffled more feathers. The medical director is not happy that the chief executive has been sent a report without his input.
A letter of response to Mr Glasgow shows you are willing …
- SIMS ARTICLE 3: INTERNET PAGES
The Internet pages are divided into "feedback" and "in tray". Feedback gives some of the actions taken over the previous management problems.
Article 3 - FEEDBACK
SWOT ANALYSIS. CONFIDENTIAL FOR DR YORK ONLY.
Good workload and in good geographic position.
Reasonable SHO numbers
Staff grade posts
Good nursing staff
Good speciality mix in inpatient teams.
Long waits at weekends
Poor physical space.
Equipment poor (old ECG machines, no blood gas machine)
Nursing a bit "traditional"
Improve waiting times
? A&E Modernisation money
Improve teaching program
Some specialities not helpful
Withdrawal of training recognition.
3 key actions:
Discuss with Mr London
Time out with A&E staff
Discuss with management - probably at CEO meeting
PROPOSED SHO TEACHING PROGRAMME
Dr York, Dr Ireland & Miss Devon
Mr London, Dr York & Mr Bathi
The Sick Child I
Mr London, Dr Ireland & Dr Wales
Emergency Radiology I
Dr Xavier Ray
Ophthalmology in A&E
Mr U V Itis
Dealing with Relatives
Sister Lisa Ash
The Major Incident Plan
Dr H Hamley
How to Teach
Emergency Radiology II
Dr Xavier Ray
The Sick Child II
Spinal Cord Injuries
Funny Dos in the Elderly
ATLS, ALS & APLS Revision
Dr York, Dr Ireland & Mr Bathi
Mr T Nutcracker
Dr H Hamley
Drugs & Alcohol
Obs & Gynae In A&E
Medico Legal Problems
Audit & Research
Burns and Scalds
Mr AO Screw
Dermatology in A&E
Stress in Medicine
Job Review, Feedback and Quiz
Dr York & Mr London
FILE NOTE OF TIME OUT WITH A&E STAFF (DR YORK)
Did SWOT analysis and the staff mostly agreed with my own thoughts.
Main problems identified were long waits especially at weekends, very poor equipment and accommodation and problems with finding beds. Nurses were a bit frustrated about restriction of extended roles. Doctors felt that the nurses could do more such as ECG�s , bloods and simple suturing.
Nurses thought that some doctors did not work efficiently and this meant long waiting times. SHOs spend a lot of time in writing notes. Nurses felt a bit unsupported by senior medical staff.
Very clear vision that we want to be an excellent DGH A&E.
Service objectives - Cut waits for minors. Improve trolley times. ENP. Extended roles. More senior doctors.
Teaching objectives - No nurse teaching at present: start nurse education program. Improve SpR teaching/training.. Improve SHO teaching. ? Start ATLS course.
Management objectives - Improve influence on the directorate. ? Move to general medicine. ? Own directorate. Regular staff meetings with reps from all staff groups and grades. Start planning for new building. GET MORE EQUIPMENT!!
Audit/research - Start some regular sessions with all staff on audit- start with waiting times. Examine reasons for Trolley waits. SpR projects in audit. Nurse audit of patients that could be seen by nurse practitioner. ? Consider participation in multicenter trial.
LETTER FROM DR YORK RE REQUEST FOR MORE INFORMATION
Dear Mrs. Penny,
Thank you for your letter and the request for more information. I can add little to the facts. I have talked to the staff again and both are clear that meningitis was in the differential diagnosis. The SHO says that he said this when he referred the case to the medical registrar.
I can assure Mrs. Green that Janice�s learning problems did not mean that she had less care. On the contrary we try to be extra careful in patients where the communication may not be easy.
As I have said previously I would welcome and the chance to discuss this directly with Mrs. Green.
LETTER FROM THE TRUST TO MRS GREEN
Dear Mrs. Green,
Thank you for your letter. We have asked for further information. The A&E department and the medical department would like to re-assure you that Janice�s learning problems would not in any way affect the level of care. Indeed the doctors are aware that they need to be extra careful when there might be communication problems. The main problem seems to be that the symptoms and signs were not typical of meningitis and the doctor thought a water infection a much more likely cause of the fever.
Dr. York the A&E consultant would be happy to meet you and to discuss these problems. If you would like to do this please contact Mrs. Penny our Quality Co-ordinator on the telephone number given above.
Again the staff and myself wish to convey our condolences and are willing to answer any further questions .
Article 3 - IN TRAY
Letters of complaint about waiting time and letter from Dep. Chief Exec.
Dear Dr. York,
I believe that you were on duty last weekend. I was the duty manager and I took two separate complaints about waiting times is the A&E department. I have passed these onto the Patient Partnership department and no doubt you will be asked to comment through the normal complaints procedure. However I believe that Ms. Butcher has already asked for your advice on this problem. The Trust Board wishes some action on this issue. The improvement in waiting times in A&E departments is one of the main targets listed in the National Plan for the NHS and I would be grateful for your plans on how to improve the situation.
Dear Dr. York,
Please find enclosed two complaints that were received by telephone last weekend. I believe you were on call. I would be grateful if you could investigate the issues raised and reply within two weeks.
- I waited 5 hours to see a doctor. I saw Dr York. She was very rude and said that I should have gone to my GP with my painful knee. I did this and my GP has sent off an immediate request for an urgent appointment with a specialist. Obviously there is something seriously wrong and I hope you will take action against the uncaring Casualty doctor.
- I realise that Accident and Emergency doctors are very busy especially at weekends but I had to wait 6 hours with a cut to the finger that needed two stitches and a tetanus injection. Could this not have been done by a nurse and so freeing the doctor for more urgent cases. I do not usually complain but I feel that with some thought it should be possible to improve the service for such minor problems.
NEED REQUEST FOR INDEPENDENT REVIEW.
Note from Sister Ash
- Last night the ECG broke down. The "back up" is so ancient that we could not find any paper for it. I had to go personally to Ward 6 to borrow their machine AND TAKE IT BACK!!!!. We have been asking for a new machine for ages. All other wards seem to have "pagewriters" that make it so much better to put in the notes. Can you do something about this? The nurses are fed up and frustrated. Ta.
Letter from Deputy Chief Exec about legal claim.
(for those that acted on the "results" then this does not apply).
Dear Dr. York.,
As you may know, one of my responsibilities (with the Medical Director) is that of Clinical Governance. The enclosed letter from solicitors seems to highlight a problem with your risk management procedures. I wonder if you could send me the departmental policy on the review of tests and recall of patients.
Re- Karen Sims
We would like to apply for full disclosure of the medical records for the above patient to investigate a possible claim for negligence. Our client instructs us that she attended your department after a road traffic accident when she injured her neck. She was told the X-ray was normal. She consulted her GP as she continued to have symptoms. Her GP was informed that the X-ray was not normal and our client has been referred urgently as a private patient to a neurosurgeon. The prognosis is not certain but our client is severely disabled at the present time.
We seek voluntary disclosure under the pre-action protocol. Please reply within 14 days or we will commence formal proceedings.
Waiting time statistics
% seen within 1hr
% seen 2 hours
% waiting > 4hrs.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.