Tom Bircher

Understanding corridor and escalation area care in 165 UK emergency departments: a multicentre cross-sectional snapshot study Introduction Emergency department (ED) crowding is an international concern. It results in care being delivered in non-standard treatment spaces including corridors, termed escalation areas in the UK....

Nearly a fifth of ED patients are in “temporary escalation spaces” - that’s a space that wasn’t designed to deliver care.

emj.bmj.com/content/earl...

I don’t think it’s ok.

We’ve released our clinical fellow jobs.

These are great if you’ve finished F2 but aren’t sure what’s next.

Self rostered.
20% Non-clinical time.

We get consistently excellent feedback for them

www.jobs.nhs.uk/candidate/jo...

People with hip fractures, they need to be assessed immediately have a block and go directly to the ward.

People under arrest brought in by police.

People with open fractures.

People who might be having a heart attack.

People who might be having a stroke. We need to act FAST.

People with an acute visual disturbance.

Back pain with red-flags for cauda equina, as this is a surgical emergency.

People who trigger red-flag sepsis. Obviously they need seeing first.

People who are receiving chemotherapy, they could have neutropenic sepsis.

People with autism. The ED environment is particularly unpleasant for them.

Patients with a known bleeding disorder. They need to be prioritized.

Obviously pregnant women. They need to be seen quickly.

Neonates. Feverish neonates especially.

Staff

People in mental health crisis brought in by mental health staff.

People in mental health crisis brought in by police.

People who are having end of life care.

Individuals with severe frailty.

Trauma patients.

But elderly trauma patients more.
Also children.

Here is a list of people who I have been told should be prioritized for early assessment in the emergency department:

If you were wanting to save a bit more money you could always reduce NHS111 opening hours to 06:00 —> 23:00 rather than 24/7

Do you know how many PAs is in their job plan for this?

How do you select topics? What about training for higher speciality docs?

Different day? How’s that work?

Who coordinates it?

How much of someone’s job plan should be devoted to planning and delivery?

How long should it be?
Who runs it?
What happens if a resident gets a repeated session?

What’s the BEST way of doing emergency department resident doctor teaching?

If someone needs you, you see them. Don’t *not* see them because you think you don’t have space.

If doctors had to manage patient care AND bed state it creates a massive ethical conflict of interest.

Hi everyone.

If you happen to be an on call doctor for a speciality can I remind you that *you* are not responsible for finding a bed for a patient. That is the job of the hospital ops/site team.

Now, I agree with you but I’m keen to explore other attitudes. Some people feel this isn’t ED work and should be done by a ad-hoc arrhythmia/cardiology service.

What do you think?