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Patients should be reviewed by a consultant once every 24 hours, report says

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8262 (Published 04 December 2012) Cite this as: BMJ 2012;345:e8262

Re: Patients should be reviewed by a consultant once every 24 hours, report says

It is very interesting to note that the third key standard recommended by the Academy of Royal Colleges, that of ensuring support services in hospitals and community settings to be "available daily to ensure that the next steps in the patient's treatment, as determined by the daily consultant review, can be taken", comes with a post-script disclaimer of not having the scope to explore the actual availability of these community services. Having been employed in the health service for a few months and watching the journey of patients from the A&E to discharge, I would recommend an audit to compare the time spent by an average medical patient in active clinical care with the time spent awaiting the patient’s discharge until agencies in the community get their assessments done and accept these patients.

It is appalling to observe clinical resources like hospital beds, investigations along with the resource being fought for here, consultant’s time in hospitals, being drained on care and review of well, fit-for-discharge patients. Maybe a sustained nationwide campaign over the everyday intellectual and financial drain because of this bottleneck at discharge end and opposing all attempts to decouple hospitals with community services holds the key to streamline healthcare delivery. Employing more consultants, increasing consultant supervision and instating more hospital beds is futile without a buttress of well-funded community agencies and resources, unless we want to create super-sized one-stop sanatoriums.

Competing interests: No competing interests
20 December 2012
Karan Singh Arora
Foundation Year 1 doctor
Princess Royal Hospital
51 Princes Terrace, Brighton, BN2 5JS
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