Avoiding delays in emergency admissions

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6929.660 (Published 05 March 1994) Cite this as: BMJ 1994;308:660
  1. R Madhok
  1. Tees Health Joint Administration, Middlesbrough TS7 0NJ.

    EDITOR, - Once a decision has been made to admit acutely ill patients it is absurd to keep them waiting on trolleys in busy accident and emergency departments while hard pressed junior doctors search for beds to accommodate them. Charging the hospitals with the responsibility to ensure a minimum wait1 may help to alleviate the sufferings of patients and the staff. Achieving the objective may, however, be challenging, given the various trends: increasing numbers of acute admissions, decreasing numbers of hospital beds and restrictions on junior doctors' hours of work, and the focus on quality of care. One partial solution may be the introduction of “facilitating units.”2,3

    Briefly, a facilitating unit - comprising an admission ward, operating theatres, coronary and intensive care units, and adequate diagnostic facilities and located next to the accident and emergency department - would allow quick admission and early treatment by senior registrars, who would be resident for their on call periods in rooms adjacent to the unit. Next day the patients could be transferred to wards elsewhere, thus freeing the unit for another day's emergency intake. The facilitating unit offers many advantages and could be introduced with relatively little investment.

    Increasing demand for services and decreasing resources mean that new ways of delivering health care must be explored. The model has been operating in a local hospital and has resulted in speedy admissions for patients with trauma and less trouble for staff. Because of this success the model is being piloted for medical emergencies. Other hospitals may wish to follow suit.

    The facilitating unit is modelled on the system at the hospital where I trained in New Delhi, India, and which my colleague Ian Holtby, with whom I proposed this model, observed in Nigeria. Lately the fashion in Britain has been to look across the Atlantic for ideas about delivery of health care; it is time we broadened our horizons and looked elsehere too for more innovative and cost effective methods.


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