Consultant triage cuts emergency admissions by a third, report finds
BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3701 (Published 03 August 2017) Cite this as: BMJ 2017;358:j3701
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I read Sophie Arie's report "Consultant triage cuts emergency admissions by a third" (1) with dismay. She found that a study concluded that if consultant surgeons triaged "at the font door" emergency admissions would be reduced by a third, saving the NHS £108m a year. What are we doing to our young surgeons? They take responsibility very seriously but are finding their work being taken over by consultants. We are interfering with their experience and self-confidence.
The Royal College of Surgeons of England seems to take a similar view. In "Whos who in the surgical team" (2) they say, "Foundation doctors [FY1 and FY2] with a keen interest in surgery may be given opportunities to assist in minor elements of surgery under close supervision". What are we coming to? These same doctors, who presumably need close supervision when putting in a skin stitch, are left to take life or death clinical duties looking after a couple of hundred in-patients at night with grossly inadequate help (3).
Lay people believe that care by a consultant is always the best care. It is not. As consultants age they begin to fall behind their senior trainees in treating emergency admissions especially at night. When I was a junior consultant I had to rescue a senior colleague who had decided to send his residents home during a political dispute. I found him slumped over the night sister's desk at 1am. He had removed an appendix, clerked a couple of patients, failed to get an intravenous line in and was completely demoralised.
References
1) bmj 2017;358:j3701
2) rcseng.ac.uk/patient-care/surgical-staff-and-regulation/whos-who-in-the-surgical-team
3) Clarke R. Your life in my hands. London: Metro Books 2017
Competing interests: No competing interests
Re: Consultant triage cuts emergency admissions by a third, report finds
The above article throws light on the busiest area of the hospital and the cut down in the duration of hospital stay in emergency services. Although the above study results are from the perspective of surgical emergency admissions, the same also happens with medical emergencies. In a large tertiary care hospital in a northern part of India, a resident doctor does the triage and manages the case overnight and the consultant sees the case next morning and decides regarding the further stay of the patient in the emergency department. A consultant managing the triage area would definitely cut down the duration of hospital stay even in medical emergencies. A study of this kind in the medical emergency department would definitely help in decreasing the morbidity of patients in a resource constrained country like ours.
Competing interests: No competing interests