Friday, 27 June 2014

Cross Site Working

Modern day NHS hospitals have flocked to the idea of “separating the elective from the emergency”. This is a managers dream of removing the profitable cherry-picked easy cases from the battlefield of the acute emergency.

In theory it works.

Patients have a booked slot, they attend pre-admission checks, get letters with plenty of warning, are appropriately fit for the operation, beds are ready well in advance and nobody ever has a problem. The emergencies also never have to wait for a bed, are whisked out from A&E and sorted at great speed, ready to be rehabilitated.

Except this never happens.

The elective site is distant from the emergency site, sometimes by a mile, sometimes by an hour's drive. Doctors, nurses and patients have to be shuttled between sites at great cost and upset. Notes get lost. Infrastructure must be duplicated. Beds get full. Elective patients have complications. Cover gets stretched between sites. Rotas become incomprehensible. Nurses and doctors become deskilled. Staff morale drops. People go off sick. Patient experience plummets. Reputations die. Patients die. Hospitals die.
The clinical staff get the blame, whereas the managers are at fault. Trainees emigrate. You don’t have to care for this to fail.

Or you can have everything on one site, including a private wing (funnelling money into the same hospital rather than another one), and then all of sudden you find that everyone knows where everyone else is, the bed capacity is large enough to cope with flux, the medical speciality cover is sufficient for all to be seen by an appropriate specialist, with training part of this, provided at a respected and liked centre. You do have to care though for this to work.

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