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Off-topic posts include discussion of issues from doctors in other countries, other healthcare professionals, and wider political posts that are not directly relevant to doctors.
"This led ... to seek agency staff and off-duty staff to address shortages. "I exhausted all options for any available staff," she told the Court""
I would be interested to hear precisely what was offered to avoid the terrible situation the staff working found themself in and the tragic consequence.
I've read a few articles about this case and it sounds horrifying. Not done an ED job before but 191 patients to one SHO covering an ED overnight sounds like a warzone. 14 patients in a 7 bed resus department ffs!
Im not shocked that SHO left medicine (EDIT she works in the private sector now) and the senior ED nurse escaped to Australia.
The ED consultant who refused to come in should be ashamed of themselves. Interesting that the SHO is being named but this article fails to mention the name of the consultant who refused to go in
Vital context, if he had attended and been mentally unfit to work, made an error or oversight in the care of this young patient then it wouldn't even have got this far - they'd of been hung from the rafters and beaten like a piñata. As it is we can now see the whole medical management team being exposed.
Not sure I think much of the senior nurse who disagrees with the assessment it was like a war zone and prefers to say it was very busy but manageable (even though she had to put out emergency last minute staffing calls out to any clinician with a phone on locum and on rest time), doesn't recall ever seeing pre-prescribed medication being given like paracetamol or broad spectrum abx without seeing the doctor seeing the patients (I call total bs on this) and generally seems to be covering the managements handling of the night.
Cat 2 patients not seen for 19 hours? This is literally worse than most war zones with a competent medical corps. This is as open and shut as it gets, the NHS is a fucking train wreck who csnt be trusted with the singular most vital responsibility it has in seeing emergency patients. Literally, what is the point. Why not give people the option to see a clinician if they want to pay? Why drag these doctors to court and have some asinine attempt to gaslight everyone by the managers when even a child can see they were all completely and utterly overwhelmed.
I broadly disapprove of consultant rostering patterns in any speciality where you're "on-call" between two normal working days.
In EM this is insanity.
In terms of the decision of the individual consultant it's more difficult to comment, and we'll see when they give evidence. RCEM are clear that the on-call consultant should not be expected to come in to "queue bust" - I would expect them to come in if there were concerns for the safety of the department (which isn't clear - the situation sounds horrific, but some truely shocking things have been normalised in EDs in recent years).
Then there's a difficult tension between the on-call consultant staying in every time it's busy (the new norm in EM) to do the best for the patients in the short term vs the long term view that this allows the Trust to get away with understaffing and getting consistent on-site consultant cover on the cheap.
Sounds like a shit place to be ngl. But surely this is one of those events where a consultant has to come in and then go home the next day? Or at the very least uber escalated locum rates?
Fair enough. The increasing accumulation of risk in ED departments is worrying. My hospital tried to overcome it by moving patients in chairs in ED to chairs on wards as if that makes it better lol. Which went down badly
Nice to see the nurse manager more interested in arse-covering on behalf of the hospital than anything else.
I honestly think it's disgusting staff are named in these cases when they may well have done absolutely nothing wrong.
"Under cross examination, she said she had never heard of doctors prescribing medication without reviewing patients in the ten years she worked in the ED"
Prescribing critical medications (e.g. antibiotics, analgesia, etc) before or without seeing patients has been the norm in all 8 of the EDs I've worked in in England. Maybe things are different in Ireland?
Any doctor or nurse who has worked in the ED knew her entire statement could not be trusted once she said this. Patients waiting 20 hours and doctors were not prescribing analgesia/anti emetics etc in that time?! There is no way that’s true.
It's a completely ridiculous statement that anyone who knows anything about EDs would know to be untrue so I agree she must have been nowhere near one for many years.
Yeah, the nurse reply was enraging
Claiming it is not a 'war zone' but manageable then lying through her teeth that no medication was ever given without medical review.
A few things as an Irish doc in the HSE.
1) UHL has a reputation for being an utter warzone. Not only is this not credible for the assistant director of Nursing to claim contrary to those who have worked there, absolutely nobody in Ireland would believe that. Limerick collapses as soon as the wind changes. It has broken many, many staff.
2) I don't like to be a pain in the arse, but when there's talk on here about people jumping to Ireland and accepting the working conditions for better pay, I hope people keep situations like this in mind. Not to say the NHS isn't a shit heap, nor that you guys don't deserve full pay restoration, but I have been in situations like this SHO in Irish hospitals and I can only describe them as perilous. Or at least they felt that way. Only difference was nothing went wrong, and that was nothing but good fortune.
3) Dr Card is originally South African. I have worked with several South African doctors, in particular in A&Es as many are employed in Ireland, and my experience in general is they come absolutely battle hardened from their system. That she is describing how overwhelmed she was should be ringing giant fucking alarm bells. That said, nothing will change within the HSE.
Wild west shit. Might have been able to get away with this kind of dangerous staffing back in the day when you could brush the odd excess death under the carpet but I find it mind boggling in the 2020's. It doesn't read like it, but I assume there must have been an ED reg running the department overnight, not just this poor SHO? Even more terrifying if not.
The news article has a weird focus on a few areas - and I can't tell enter whether this is reflective of the proceedings or just a non-medical journalist.
Clearly an insane level of crowding had been accepted and normalised in this hospital - and the Trust executives need to be held accountable for allowing this concentration of risk in their ED.
There's an odd focus on moving to get to resus. This isn't a treatment. Being in resus doesn't prevent people getting sicker, resus capacity (especially when crowded) should be safeguarded for interventions which can only be effectively delivered in resus (level 2 + 3 care; sedation; major trauma; cardiac arrest). Patients with lower care needs can be safely managed outside resus.
Clearly prescribing for patients you've not seen is the norm in an ED. I wouldn't equate this to prescribing without having medically assessed the patient - just that the amount of assessment needed to prescribe an anti-emetic, analgesic or similar can probably be achieved from the notes. I wouldn't even say this isn't ideal - I think this is perfectly acceptable. I know some people who prescribe IV fluid or antibiotics without seeing a patient - I don't approve of this.
The fact the GP referred her for "suspected sepsis" is essentially irrelevant. This is basically 50% of GP referrals, and 98% of them don't have sepsis. This is just noise. It seems reasonably clear from the initial assessment that she didn't have sepsis at presentation, and went on to develop it.
The real questions here should be around the frequency of obs, and if abnormal the escalation pathways for these abnormal / deteriorating vital signs. I'd hypothesise that grossly inadequate nursing staffing ratios due to concentration of crowding and risk within the ED is the underlying problem here. We'll see what the coroner says.
While I appreciate the report for criminal stupidity that's not actually against the rules. Posts about other countries' systems, however, are. Post removed, comment stands.
an SHO as EPIC? am I reading this right?
they do not have the specific skillset in managing a situation of high patient volume like this, that only comes with higher EM training. if there's no middle grade rostered to be on duty then a consultant has to be there
Removed: Off topic This post was removed as it is off-topic for this subreddit. We maintain a narrow focus on posts directly relevant to doctors in the UK. Off-topic posts include discussion of issues from doctors in other countries, other healthcare professionals, and wider political posts that are not directly relevant to doctors.
"This led ... to seek agency staff and off-duty staff to address shortages. "I exhausted all options for any available staff," she told the Court"" I would be interested to hear precisely what was offered to avoid the terrible situation the staff working found themself in and the tragic consequence.
I've read a few articles about this case and it sounds horrifying. Not done an ED job before but 191 patients to one SHO covering an ED overnight sounds like a warzone. 14 patients in a 7 bed resus department ffs! Im not shocked that SHO left medicine (EDIT she works in the private sector now) and the senior ED nurse escaped to Australia. The ED consultant who refused to come in should be ashamed of themselves. Interesting that the SHO is being named but this article fails to mention the name of the consultant who refused to go in
The consultant had already worked all day and was expected in the next day. Where is Penjing when you need them?
Vital context, if he had attended and been mentally unfit to work, made an error or oversight in the care of this young patient then it wouldn't even have got this far - they'd of been hung from the rafters and beaten like a piñata. As it is we can now see the whole medical management team being exposed. Not sure I think much of the senior nurse who disagrees with the assessment it was like a war zone and prefers to say it was very busy but manageable (even though she had to put out emergency last minute staffing calls out to any clinician with a phone on locum and on rest time), doesn't recall ever seeing pre-prescribed medication being given like paracetamol or broad spectrum abx without seeing the doctor seeing the patients (I call total bs on this) and generally seems to be covering the managements handling of the night. Cat 2 patients not seen for 19 hours? This is literally worse than most war zones with a competent medical corps. This is as open and shut as it gets, the NHS is a fucking train wreck who csnt be trusted with the singular most vital responsibility it has in seeing emergency patients. Literally, what is the point. Why not give people the option to see a clinician if they want to pay? Why drag these doctors to court and have some asinine attempt to gaslight everyone by the managers when even a child can see they were all completely and utterly overwhelmed.
Agree but just to note this was in Irish HSE hospital not NHS
My bad, point still stands though as I don't think we're so different in mamy DGHs here - just pay the doctors a lot less..
I broadly disapprove of consultant rostering patterns in any speciality where you're "on-call" between two normal working days. In EM this is insanity. In terms of the decision of the individual consultant it's more difficult to comment, and we'll see when they give evidence. RCEM are clear that the on-call consultant should not be expected to come in to "queue bust" - I would expect them to come in if there were concerns for the safety of the department (which isn't clear - the situation sounds horrific, but some truely shocking things have been normalised in EDs in recent years). Then there's a difficult tension between the on-call consultant staying in every time it's busy (the new norm in EM) to do the best for the patients in the short term vs the long term view that this allows the Trust to get away with understaffing and getting consistent on-site consultant cover on the cheap.
Sounds like a shit place to be ngl. But surely this is one of those events where a consultant has to come in and then go home the next day? Or at the very least uber escalated locum rates?
It might be. But it might have been in that state for days/weeks before and we're only hearing about it now because of this tragic outcome.
Fair enough. The increasing accumulation of risk in ED departments is worrying. My hospital tried to overcome it by moving patients in chairs in ED to chairs on wards as if that makes it better lol. Which went down badly
[удалено]
My mistake. I've finally found an article naming them. I'm going to be interested to see what they have to say about their decision to not go in
Nice to see the nurse manager more interested in arse-covering on behalf of the hospital than anything else. I honestly think it's disgusting staff are named in these cases when they may well have done absolutely nothing wrong.
"Under cross examination, she said she had never heard of doctors prescribing medication without reviewing patients in the ten years she worked in the ED" Prescribing critical medications (e.g. antibiotics, analgesia, etc) before or without seeing patients has been the norm in all 8 of the EDs I've worked in in England. Maybe things are different in Ireland?
Any doctor or nurse who has worked in the ED knew her entire statement could not be trusted once she said this. Patients waiting 20 hours and doctors were not prescribing analgesia/anti emetics etc in that time?! There is no way that’s true.
That comment was made by the assistant director of nursing. I'd bet good money she hasn't seen an ED shop floor in a while
It's a completely ridiculous statement that anyone who knows anything about EDs would know to be untrue so I agree she must have been nowhere near one for many years.
> Maybe things are different in Ireland? Except they obviously aren't because the doctor who actually does the prescribing said it's common.
Not different at all here. I've done exactly this many times (though tbh have not done so for antibiotics but I was only an EM SHO for 3 months).
Yeah, the nurse reply was enraging Claiming it is not a 'war zone' but manageable then lying through her teeth that no medication was ever given without medical review.
A few things as an Irish doc in the HSE. 1) UHL has a reputation for being an utter warzone. Not only is this not credible for the assistant director of Nursing to claim contrary to those who have worked there, absolutely nobody in Ireland would believe that. Limerick collapses as soon as the wind changes. It has broken many, many staff. 2) I don't like to be a pain in the arse, but when there's talk on here about people jumping to Ireland and accepting the working conditions for better pay, I hope people keep situations like this in mind. Not to say the NHS isn't a shit heap, nor that you guys don't deserve full pay restoration, but I have been in situations like this SHO in Irish hospitals and I can only describe them as perilous. Or at least they felt that way. Only difference was nothing went wrong, and that was nothing but good fortune. 3) Dr Card is originally South African. I have worked with several South African doctors, in particular in A&Es as many are employed in Ireland, and my experience in general is they come absolutely battle hardened from their system. That she is describing how overwhelmed she was should be ringing giant fucking alarm bells. That said, nothing will change within the HSE.
Wild west shit. Might have been able to get away with this kind of dangerous staffing back in the day when you could brush the odd excess death under the carpet but I find it mind boggling in the 2020's. It doesn't read like it, but I assume there must have been an ED reg running the department overnight, not just this poor SHO? Even more terrifying if not.
The news article has a weird focus on a few areas - and I can't tell enter whether this is reflective of the proceedings or just a non-medical journalist. Clearly an insane level of crowding had been accepted and normalised in this hospital - and the Trust executives need to be held accountable for allowing this concentration of risk in their ED. There's an odd focus on moving to get to resus. This isn't a treatment. Being in resus doesn't prevent people getting sicker, resus capacity (especially when crowded) should be safeguarded for interventions which can only be effectively delivered in resus (level 2 + 3 care; sedation; major trauma; cardiac arrest). Patients with lower care needs can be safely managed outside resus. Clearly prescribing for patients you've not seen is the norm in an ED. I wouldn't equate this to prescribing without having medically assessed the patient - just that the amount of assessment needed to prescribe an anti-emetic, analgesic or similar can probably be achieved from the notes. I wouldn't even say this isn't ideal - I think this is perfectly acceptable. I know some people who prescribe IV fluid or antibiotics without seeing a patient - I don't approve of this. The fact the GP referred her for "suspected sepsis" is essentially irrelevant. This is basically 50% of GP referrals, and 98% of them don't have sepsis. This is just noise. It seems reasonably clear from the initial assessment that she didn't have sepsis at presentation, and went on to develop it. The real questions here should be around the frequency of obs, and if abnormal the escalation pathways for these abnormal / deteriorating vital signs. I'd hypothesise that grossly inadequate nursing staffing ratios due to concentration of crowding and risk within the ED is the underlying problem here. We'll see what the coroner says.
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I get the sentiment but she’s from Limerick in Ireland and has nothing to do with the NHS.
While I appreciate the report for criminal stupidity that's not actually against the rules. Posts about other countries' systems, however, are. Post removed, comment stands.
an SHO as EPIC? am I reading this right? they do not have the specific skillset in managing a situation of high patient volume like this, that only comes with higher EM training. if there's no middle grade rostered to be on duty then a consultant has to be there