Never Mind the Bollocks: 10 Things Emergency Medicine Consultants Can Do Now to Help the NHS Stay the Best Healthcare system in the World

Scotland has a serious politics hangover, and now the party conferences have started up in earnest. The NHS is front and centre as usual, wheeled out like a beat up old Jag that mostly still goes like a dream, but has had some very unfortunate internal modifications over the years, and is currently towing a caravan full of improvement specialists. It needs some expensive work done, but the garage report says its well worth saving and is definitely much better value than using rental cars.

We know that politicians mostly talk bollocks about the NHS, influenced by which lobby group or vested interest has their ear at the time. We in Emergency Medicine on the other hand can have some real influence on whether we stay at the top of the healthcare global charts in spite of them. Here's my 10 point check for us EM consultants to do our bit, divided into DCC and SPA activities.

On the Floor: Speed, Safety, Cost-effectiveness

1.     Make clear disposition decisions based on risk, and only admit patients who really need it. Think: “If not me, then who better to be gatekeeper?”

2.     Use robust evidence-based guidelines combined with experience to assess risks and standardise treatments in the right context. Science and art of medicine.

3.     Ensure important time-critical things happen quickly. Early resuscitation, sepsis care, pain-relief, revascularisation and haemorrhage control improve quality, outcomes, patient experience and length of stay.

4.     Consider early DNR and end-of-life care when treatment futile and simply prolonging inevitable death. What would we want for ourselves?

5.     Avoid confusion and duplication by clear communications with in-patient team, GP and patient/family. What needs to happen next and by whom?

In the Meeting Rooms: Focus, Clarity, Candour

1.    Say at the start of every meeting; “This meeting will have been a success if we achieve what outcome?” If no clear answer given, leave and go do something useful for patient care instead.

2.    Do not tolerate the cruelty, danger and inefficiency of ED overcrowding. Make everyone’s life hell until they fix it - the more senior the better.

3.    Talk up the importance of EM senior cover at every opportunity, and plan how to stretch cover across as much of the day as possible. We are the answer, now what was the question?

4.    Take every opportunity to analyse, critique and evaluate EM service performance. Seek to improve every small pixel that makes up the picture. No one looks good with their head up their own ass.

5.     Teach, support and inspire trainees, med students, ambulance staff and nursing colleagues to understand the key role of EM in turning chaos into order. We are the NHS.