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Article 6. Sex, drugs, and rock and roll
  1. S McCormick,
  2. J Wardrope
  1. Department of Accident and Emergency Medicine, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
  1. Correspondence to:
 Mr J Wardrope, Department of Accident and Emergency Medicine, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK;


This is the sixth article in a series on management within the emergency department. This article focuses on disciplinary procedures and actions.

  • management
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    The Internet pages are divided into "feedback" and "in tray". Feedback gives some of the actions taken over the previous management problems.



    From Greenmound School

    Dear Dr York,

    I am the headmaster of Green Mound School in Jaemtown and I am hoping that you may be able to help us with one of our school projects. Our children regularly have to write about people in their community and we are hoping they could come and visit you at work and perhaps have a short talk about what you do. We have had a similar arrangement with the local police force for years and find it very rewarding. If you do not feel able to help us but know of one of your colleagues who could please feel free to pass this request on to them.

    Thank you

    Yours truly,

    Mr H Harmond

    Letter from Pills Chemist

    Pills Chemists
    Market Square

    Jaemtown  AE1 4AL
    01582 348 562

    Dear Dr York,

    We are a well-established local pharmacy and we are planning on opening a 24-hour pharmacy beside St Jude�s Hospital in the next few months. This will be able to dispense most of the drugs prescribed by local GPs or hospital practitioners outside normal working hours. As your department is likely to be a major prescriber during these hours we are making you aware of this facility for the use of your patients.

    You are no doubt aware that many drugs are available cheaper over the counter than on prescription and this may be useful to your patients. We are able to advise patients on the purchase of simple analgesics, antacids and many topical treatments for dermatological conditions and then provide the drugs cheaper than the current prescription charges.

    In an effort to raise our profile we would be willing to sponsor the advice cards your department uses to help patients with certain conditions such as head injuries or soft tissue injuries.

    I am sure this could be an arrangement that would benefit us both.

    Please feel free to contact me at anytime at our town centre branch.

    Yours sincerely

    William Pills



    Private letter from Dr Wales to Staff Nurse Holly

    Dear Jenny,

    I am sorry that we have ended up in the middle of such a formal complaint. I am sorry that I upset you with my behaviour at work and the Christmas party. I am also sorry that you felt unable to approach me directly with your concerns as I have always felt that I had a good relationship with most of the nursing staff. In any case, no hard feelings and I look forward to working with you in the future.

    Dr Philip Wales



    Dear Dr York,

    My name is Polly Martin and I am wondering if you could help me.

    I am the agent of Shane Simons and he is currently working on the video for his next single "High Charge Lover". During the video Shane will be rushed in to hospital with an apparent cardiac arrest and despite electric shock treatment would not be revived until he received a �High Charged� kiss from his girlfriend. We feel the image would be quite powerful and Shane feels it would be more realistic if it were shot in a real hospital with as many real staff as is possible.

    You will probably be aware that Shane is a local lad and has supported St Jude�s hospital on a number of occasions with donations. He is willing to pay with a personal donation to your department in the form of equipment to the cost of �5000. As you can see this could be an arrangement of mutual benefit.

    I hope I hear from you soon.


    Polly Martin



    The following is an extract from the notes of relevant entries of Susan Smith:

    03/02/01 Seen following a RTA rear end shunt neck pain. Limited range of movement.Physiotherapy (2/52 sickness certificate)

    17/02/01 Still neck pain not seen physio. (2/52 sick note)

    3/02/01 improving (return to work 10/3/01)

    5/09/00 3 weeks history of neck pain. Stiff in mornings no trauma. Range of movement good but with limitation of rotation and extension . Probable spondylosis. Analgesia Advice on mobilisation.

    5/10/00 UTI - antibiotics. Neck much better. Now full range of movement.

    Previous history. Back pain 1994, physio and 3 weeks off work.

    No other significant entries.


    Capital project application form.

    Why do you need the equipment/building

    The increasing medical workload is making it imperative that the A&E department has a readily accessible blood gas machine. Up to 20 patients per day need this investigation. Often these are the sickest patients in whom minutes may count in making vital life saving decisions. At present the blood gas analysis is performed in the Laboratory. This entails inevitable delays. The time and extra work involved also may be a factor in the under use of this investigation. A recent departmental audit (appendix 1) revealed that many patients with primary respiratory pathology, who would have benefited from blood gas analysis, were not having them taken. When inquires were made in to this it was discovered that many members of staff felt that there was no point in taking the samples as the results were irrelevant by the time they were returned.

    The current situation requires samples to be sent to the laboratories using the portering service, a service that is already over stretched, and then results telephoned back to the department when a member of laboratory staff is free to do so. This complicated and unwieldy process is often extended during on-call hours when a technician may be called in from home to carry out the analysis. It is not uncommon for �emergency blood gases� to be phoned back to the Accident and Emergency department after the patient has already left for a ward.

    Near patient blood gas analysis is one of the recommended practices in many Standards of Service for A&E departments (eg Health Services Accreditation 1997)

    In summary the lack of a blood gas machine is giving rise to concerns about the level of clinical care we can deliver and also slows the running of the department.

    We have discussed this proposal with laboratories have confirmed a willingness to cooperate.

    Capital Costs

    Blood Gas Analyser (co-oximeter). �34,000
    Installation costs. �500

    Revenue costs (and who will be responsible)

    Service contract �800
    Daily servicing �2,400

    The revenue costs are to be included as a service development in this year's SaFF plan.

    It should be noted that current estimates for blood gases are �21.50 per sample but our near patient testing is estimated at �11.50 per sample.


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