25 November 2010

Pesky sick people pestering the hospital

| johnboy
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The ABC is carrying outrage from ANU’s Professor Drew Richardson that the nurse-staffed walk-in clinic at the hospital has correlated with increased workload in the emergency department.

Causation is implied.

“In the 20 weeks after the walk-in centre opened the emergency department had 10 per cent more presentations than in the 20 weeks before,” he said.

“Now it is a little seasonal and based on the past three years we’d expect 7 per cent more, but 10 per cent more is a significant increase.”

Professor Richardson says the idea of associating walk-in centres with hospitals needs to be reviewed.

“We certainly shouldn’t open any more on hospital campuses and we certainly should give consideration to whether a hospital campus is the right location if this sort of service is to be provided anywhere,” he said.

It’d be a great hospital if it wasn’t for the patients.

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Jethro said :

Wily_Bear said :

Speaking from a consumers perspective, I wholeheartedly support this initiative. I tried this service for the first time today, and can report an overwhelmingly positive experience.
I presented with a child with a (mild) yet chronic health issue, which tends to be exacerbated by the common cold or flu.

There’s nothing common about a flu. I hate how the word is misused with reckless abandon. ‘Flu’ is short for influenza, a deadly disease that wiped out more people in the couple of years following World War I than the war itself did.

People presenting with the flu are usually seriously ill.

I completely agree Jethro- I have a full appreciation of the effects of influenza, as distinct from the cold. I did say common cold, not common flu- the latter being far less common than the former. Probably just expressed myself poorly!

Wily_Bear said :

Speaking from a consumers perspective, I wholeheartedly support this initiative. I tried this service for the first time today, and can report an overwhelmingly positive experience.
I presented with a child with a (mild) yet chronic health issue, which tends to be exacerbated by the common cold or flu.

There’s nothing common about a flu. I hate how the word is misused with reckless abandon. ‘Flu’ is short for influenza, a deadly disease that wiped out more people in the couple of years following World War I than the war itself did.

People presenting with the flu are usually seriously ill.

I especially liked this sentence in his rant about the 3% increase:

“Some of those who are attracted to the walk-in centre are not suitable for the walk-in centre and are sent to the emergency department.

“Previously some of those people may have gone to a GP or may have gone nowhere at all.”

So these people are sick enough to not qualify for treatment by a nurse. If they are going there during normal GP working hours, his complaint is somewhat justified. But if the nurse can’t treat them or send them home, surely it’s not in the patients’ interest to go “nowhere at all”???

Pesky patients indeed… They should’ve kept the walk-in centre a secret!

Speaking from a consumers perspective, I wholeheartedly support this initiative. I tried this service for the first time today, and can report an overwhelmingly positive experience.
I presented with a child with a (mild) yet chronic health issue, which tends to be exacerbated by the common cold or flu. Like many parents of kids with long standing conditions, I required a certificate for my employer due to having so many days off this winter. Having had several very poor experiences with other health services in Canberra, I wasn’t expecting much.
It was a pleasant suprise to have the attending nurse undertake a range of careful investigations of the problem- which no GP has bothered to do since our dear family doctor passed away some years back. She spent sufficient time to check our understanding of the management of the underlying condition, and we left armed with loads of information and better knowledge of signs and symptoms that indicate the need to seek a consultation with a GP. Moreover, the nurse spoke to the lil’ bear, not over his head to me, something he appreciated enough to make mention of afterwards. All this in under 40 mins, and it was free !
Oh, and I received a certificate which meets the requirements of my employer.
Many thanks to the great staff at the walk-in clinic

Maybe its because the nurse practitioner took 2 hours to figure my that friend had a wrist sprain.

Or maybe it’s just the thunderstorms.

It probably doesn’t take much to increase the casualty workload. A bout of spring hayfever, fears of bird flu, the annual gastro outbreak, or a well-advertised service set up within easy walking distance.

Richardson is probably right about the walk-in clinic increasing the workload. The bigger question is whether than 10% is a group a people that should have presented to casualty anyway, but would otherwise have left it until much later and used an ambulance to get there.

That would mean focusing on health outcomes for individuals rather than statistics, trends and targets.

Now the ABC reports that Katy Gallagher isn’t planning to take action due to Professor Richardson’s report, preferring to wait until a twelve month Government review. The article also says that the 10% increase is due to people seeing the promotions about the walk-in clinic and going, only to find that their treatment is too complex for the clinic, but not serious enough for emergency.

This isn’t the first time that the ED has complained that a new service has increased their workload without proving any causal link.

I’m very sympathetic to ED staff – they do an incredibly job. They’re under-resourced and plagued by idiots who use them as a GP substitute in non-emergency situations. But blaming third parties on nothing more than circumstantial evidence doesn’t help their case.

Even if they [i]could[/i] prove causation – that the Walk-in Centre was sending them extra people – the question is surely one of appropriateness. Should the people have been sent to the ED or were there better [i]available[/i] options? Note the [i]available[/i] please; if the judgement is that the patient should see a GP but there are none available, the ED may be the only option. That’s not the Walk-in Centre’s fault nore the ED’s, and the blame game doesn’t help.

My personal view is the that Centre is a fantastic addition to Canberra’s health options and that there should be more of them. But that doesn’t excuse the grubbyment from responsibility for funding ED properly.

Inappropriate11:20 am 25 Nov 10

Lots of doctors and clinics are reporting an increase: a wetter than usual spring has resulted in more pollen in the air, it’s giving everyone respiratory problems.

Wasn’t the whole point of the walk-in clinic to move the less serious patients (people with a sniffle, bites from huntsmen spiders, scratches from drain cats) from emergency to the clinic, so the emergency staff could deal with more urgent or life threatening cases? The question is why is there a 10% increase? Is it because we have 10% more life threatening cases or because people think that now there is a walk-in clinic they have decided to go to RCH and planted themselves in emergency and couldn’t be buggered to go to the walk-in clinic.

Strange article, I spose you’d have to read the profs report to catch the link. Shouldn’t the figure be a 3 percent increase after you take seasonal adjustment and historical trends into account?

I would assume more people are turning up to emeregency with stuff the Walk-in Clinic isn’t qualified to treat under their charter which from the looks of their website is everything but minor Colds & Flu, Cuts & Abrasions, Bites & Stings, Minor Illness and Minor Injuries.

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