Nurses may make surgical house officers obsolete

BMJ open, 2018

To examine whether care provided by general practitioners (GPs) to non-urgent patients in the emergency department differs significantly from care provided by usual accident and emergency (A&E) staff in terms of process outcomes and A&E clinical quality indicators. Propensity score matched cohort study. GPs in A&E colocated within the University Hospitals Coventry and Warwickshire NHS Trust between May 2015 and March 2016. Non-urgent attendances visits to the A&E department. Process outcomes (any investigation, any blood investigation, any radiological investigation, any intervention, admission and referrals) and A&E clinical indicators (spent 4 hours plus, left without being seen and 7-day reattendance). A total of 5426 patients seen by GPs in A&E were matched with 10 852 patients seen by emergency physicians (ratio 1:2). Compared with standard care in A&E, GPs in A&E significantly: admitted fewer patients (risk ratio (RR) 0.28, 95% CI 0.25 to 0.31), referred fewer patients to othe...

BMJ Open, 2019

ObjectivesWorldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are ‘free to care for the sickest patients’. However, the research evidence to support this initiative is weak.DesignRapid realist literature review.SettingEmergency departments.Inclusion criteriaArticles describing general practitioners working in or alongside emergency departments.AimTo develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.ResultsNinety-si...

Journal of Clinical Nursing, 2006

If this is not fully appreciated, the promising, innovative nature of the role may be subsumed by organizational politics and power games, for example, by NCs having to take on parts of the medical role at the expense of developing nursing excellence. In those cases, NCs may end up frustrated, demoralized or burnt out. The NHS and nursing have a unique opportunity to provide excellence in care via highly skilled, flexible and knowledgeable consultant practitioners who are able to lead, develop innovative practice, provide expert clinical care and undertake research to improve patient outcomes. This opportunity should be seized and nurtured; it is unlikely to re-occur if NCs do not produce results that reflect the advanced nature of this type of practice.

Social Policy & Administration, 2010

The British government's requirement for expert medical advice from the 1850s led to the development of a medical civil service, which reached its peak in size and authority in the 1970s. By this time the Chief Medical Officer (CMO) had direct management of a staff of over 170 medically qualified civil servants, who provided expertise on the development and implementation of new medical treatments as well as on broader health protection and promotion issues. The successive Whitehall efficiency reviews from 1979 onwards culminated in 1994 in the merger of the parallel medical and civil service reporting hierarchies in the Department of Health, effectively reducing the CMO's ability to call upon the support of medical civil servants, at a time of increasing new health threats such as AIDS and MRSA. This article uses government reports to chart the rise and fall of the British medical civil service. It discusses how, in the last ten years, the British government has become more imaginative in its use of temporary specialist medical advisers (tsars) brought in from the NHS, in relaxing the formal civil service hierarchies, and quietly abandoning the statutory Standing Medical Advisory Committee (SMAC). This article suggests that when the government has failed to give adequate support to its CMOs, the medical civil service has suffered from poor morale, experienced recruitment difficulties, and the ability to respond to health crises has been compromised. It highlights the chronic lack of historical awareness in the development of health policy in Britain.

Journal of Public Health, 1997

The recent revival of interest in the potential of preventive medicine, reflected in its re-emergence as a medical specialism and in monitoring and campaigning activity at the local level, has been accompanied by growing interest in the history of public health. In particular, the work of the Medical Officers of Health (MOsH), the doctors appointed by many local authorities after 1850, has come under closer scrutiny. However, whereas historians have acknowledged that the MOsH played a key role in tackling environmental health and infectious disease in the second half of the nineteenth century, judgements have been less favourable for the period since 1900. It is alleged that the MOsH produced repetitive and complacent reports, delayed the introduction of immunization, and were seduced away from public health by hospital administration. Both they and their counterparts in the School Medical Service ignored wider threats to health such as malnutrition and unemployment, and campaigning on these issues was left to other individuals and pressure groups. Furthermore, it is argued that after the establishment of the National Health Service in 1948, MOsH failed to exploit the potential of health education, lagged behind thinking on social work, and were slow to develop services for 'community care'. According to this analysis, the demise of the MOH in the 1974 health service reorganization represented the logical culmination of trends in the previous 75 years. This paper examines the strengths and weaknesses of this interpretation, partly through a case-study based on the Midlands city of Leicester. It argues that, although some MOsH were complacent, all operated within the limitations of important local and national constraints, and that, given these restrictions on their room for manoeuvre, many were remarkably innovative and imaginative. The paper concludes that, until further research is undertaken, the charges levelled against these doctors remain largely unproven.

Journal of Public Health, 2002

Emergency Nurse

To deliver a patient-centred service Emergency Departments must be efficient, effective and meet the needs of the local population. Following the principles of prudent healthcare, a service redesign of unscheduled care was carried out at Prince Phillip Hospital, Llanelli to improve the patient experience. Extending the roles of specialist nurse practitioners was a major component of this redesign. Six working groups were established to guide the process, including one group with a responsibility for working cooperatively with the local community, who had concerns about perceived 'downgrading' of the Emergency Department. The service redesign was completed in 2016 and evaluation has shown that the target for patients being seen within four hours improved from 88% to 96%, significantly more acute medical admission patients were discharged in less than 24 hours and patient satisfaction increased overall.

Irish Journal of Medical Science (1971 -), 2019

Background In recent years, attrition from Emergency Medicine (EM) training in Ireland has increased. Australian data illustrates that increasing numbers of Irish-trained doctors are embarking on EM training in Australia. This has implications for EM in Ireland, particularly for Emergency Departments already under strain. An adequate supply of qualified specialist EM doctors is essential to provide high-quality patient care. Aims The aim of this study is to gain insights into the reasons for attrition from EM training in Ireland. Methods EM trainees who exited EM training in Ireland 2011-2016 were invited to complete a survey which included quantitative and free-text questions. Results Of 43 doctors who had exited EM training, 71% responded and although some respondents spoke positively about the speciality, overall, their feedback illustrated levels of frustration and dissatisfaction with EM training in Ireland. Respondents exited their EM training programme due to a lack of training received, despite being formally registered on an Irish EM training scheme. The other factors raised included dissatisfaction with the general working conditions in EM in Ireland with respondents highlighting heavy workloads, high work intensity, stress, staff shortages, and poor work-life balance. Conclusions Our findings indicate the need to improve training and working conditions in Emergency Medicine in Ireland. These improvements are necessary to reduce attrition and improve retention of EM staff.

Intensive and Critical Care Nursing, 2008

World Journal of Emergency Surgery, 2008

Background: Emergency admissions may account for over 50% of surgical admissions. The impact on service provision and implications for training are difficult to quantify. We performed a cohort study to analyse these workload patterns. Methods: Data on emergency room (ER) surgical admissions over six months was collected including patient demographics, referral sources, diagnosis, operation and length of stay and analysed according to sub-speciality and age-groups. Results: There were 1392 (median age 41 (IQR 28-60) years, M:F = 1.7:1) emergency surgical admissions over six months; 45% were under 40 years of age and 48% patients self-referred to the ER. The commonest diagnoses were abscesses (11%), non-specific abdominal pain (9.7%) and neuro-trauma (9.6%). The median length of stay was 4 (IQR 2-8) days; with older (>80 years) patient staying significantly longer than those <40 years of age (median 8 vs 2 two days, P < 0.0001, Kruskal-Wallis test). Vascular patients remained in hospital longer than trauma or general surgery patients (median 14 vs 3 days, P < 0.0001, Kruskal-Wallis test). A high proportion (43.5%) of the patients required operative intervention and service implications of various diagnoses and operative interventions are highlighted. Conclusion: With the introduction of shortened training period in Europe and World over, trainees may benefit from increased exposure to trauma and surgical emergencies. Resource planning should be based on more comprehensive, prospective data such as these.