There has been a lot of discussion this week regarding pressure on the Emergency Department at Flinders Medical Centre in South Australia.
|Rack ’em and stack ’em!|
And of course this is not just about ramping in the ED. It also applies to rural medicine, to the operating theatre, to in-patient care and to discharge.
- lack of equipment to manage a difficult airway in rural EDs and theatres
- lack of ownership of equipment and emergency training for rural staff
- cost-shifting between State and Commonwealth coffers for ED patients
- lack of discharge summaries from people who have been admitted and discharged from metro hospitals
What can we do to improve things?
Well, political pressure is one – I would imagine that Dr Di King’s resignation has served to highlight the issue locally and perhaps prod the Health Minister into action.
More so, we can engage and try to make things better. I’ve been revitalised in the past few months by some of the information coming through the blog-o-sphere, with concepts of relevance to my practice that one is not going to get from a textbook or clinical placement. So I’ve done a survey on difficult airway equipment for rural GP-anaesthetists. I’ve offered to run some small group scenario-based sessions for nursing staff at the end of each of my anaesthetic lists and whenever I am on call for A&E. And I’ve been developing a web-based repository of emergency training for local use…how to set up the oxylog, where to find and use the rapid rhino kit for dealing with an epistaxis, a dump mat for RSI etc.
Another new idea is borrowed from the UK – a ‘one minute wonder’ fortnightly update on topics of relevance for our multiskilled rural nursing staff – basically a single A4 poster explaining how to find/set up/use a piece of ED equipment – displayed on the wall above the iStat machine to give people something to read whilst waiting for the iStat or Troponin reader to do it’s stuff.
Small things, but they might make emergency management in the bush easier.
Of course, the astute reader would wonder why these initiatives are not flowing ‘top down’. It would seem intuitive to have a minimum standard of airway equipment in rural hospitals, to have standardised ED kit and protocols, to train staff in equipment use beyond the token annual ALS refresher.
But this doesn’t happen. Change takes time, there needs to be initiative and drive, and solutions need to be appropriate to the local situation.
Anyone else got any pointers to drive change and improve emergency management in rural areas?