QP avoidable emergency/urgent admissions

A rather wonderful arbitar of such by the ubiquitous Dr Spitfire;

'I have long since ignored diktats from above about reducing emergency admissions, attendences etc. 

The managers will disappear over the horizon if the shit hits the fan because you failed to admit when needed. 

When our QOF Qp indicators asked us to review our emergency admission referrals and identify any "inappropriate admissions", without actually specifying any criteria by which they were deemed inapporpriate, I set the standard thus:

The hospital team, on assessning the patient weere able, without bloods, Xrays or further investigation or monitoring beyond that of a GP service, to discharge the patient the same day.

I found we had no emergency admissions to hospital that met the criteria of inappropriate using this standard.

If the hospital team needs same day Xrays/bloods to arrive at a decision, then by default, that admission is appropriate. I will take criticism from managers or hospital consultants when patients are sent home without any investigations whatsoever. '

Johnleigh rightly comments;

'"Plus, you do know that most of the blood tests ordered on emergency admission patients are not requested by a doctor, but by the nurse at the door of the admission?"

On whose authority does the nurse do the tests? 

Ah, "the doctor's" you reply. 

I rest my case.'

and spitfire again;

'(to hospital colleagues, whom I admire a lot by the way to cope with heaving demands on them too):

tell you what in that case, next time you do a ward round on admissions as the senior doctor, tell your juniors you dont want to hear any results until you have clinically assessed the patient with the same equipment as a GP. Then decide if you can discharge without knowing them.

If you can, great, its an inappropriate referral/assessment. If you want to know the results before sending home, then you are in the same boat as the GP was.

It would be a useful teaching tool for the juniors, many of whom bemoan/interrogate us for sending up patients to be assessed (I remember I was guily of this too at that stage of training), to see if they can appreciate what it is like for us at the maximum uncertainty end, trying to make a decision in 10mins, or in an inadequate room on a soft sofa on a home visit to an acute abdomen.'