I predicted this but nobody listened.

“I told you so” is the reaction when I read Evesham man, 91, waited more than 24 hours for hospital admission on BBC News.

As a former doctor I can see what has happened here. I predicted this during my house jobs but nobody listened.

A lot of this can be avoided by simple organisation.

Post take ward rounds done by a senior doctor between 6pm-7pm and 7am to 8am.

The patient reviewed daily on a timetabled ward round.

Social assessment started on the first day of admission.

Let me explain.

Typically first on call junior doctors on emergency duty are on call 8am to 9pm for 7 days and there is a night time doctor from 8pm to 9am for 7 days. It’s called being on call or on take.

What should happen is at that 6 pm the consultant (senior doctor in charge of a team) on call should do a post take ward round and see those who came in between 8 am to 6pm. The consultant should give the junior constructive feedback and teaching as part of their training. A decision should be taken then to initiate social assessment. Then the daytime junior should then be allowed to go home. The middle grade doctors should hold the bleep and see any admissions during this ward round.

In the morning at 7 am the consultant should again review all those who came in between 8pm and 7am. The first 10–15 will be from the previous ward round. It will be “no change” “no change” etc. Then the consultant should review the later admissions. The ward round should finish by 8:30 am. By law once 10 am comes the middle grade doctors must be released to do their day job and by 9am the night time junior must be released to get 12 hours rest.

My Dad who is a GP told me that if you suspect a patient cannot cope at home then you start social assessment from the 1st day. That will get everything ready for discharge and will save the patient at least one month in hospital and repeated hospital admissions. The patient should be seen daily on a timetabled ward round. In terms of social assessment there is a medical form to be filled in and that form should be made available on the consultant ward round.

The above is rarely done and all too often the post take ward round starts at 8am and is never completed on time and patients are left without being reviewed by a consultant until they are transferred from admissions to a hospital ward. Very few hospital firms do daily ward rounds and the medical form for social assessment is NEVER on the ward round. All too often it’s given to a junior and by law a junior can’t fill them in. They get sent back and it can take ages to get them filled in. Worse still nobody thinks of social assessment until the day of discharge, the patient goes home, can’t cope, comes back in a few days later and is in for months whilst social care is sorted. This causes bed blocking.

48 hours before discharge the interim discharge letter to the GP (TTO= to take out) should be done.

Simple organisation but it’s never done. My Dad taught me to start social assessment on day one of admission, see the patient daily and do the TTO 2 days before expected discharge. None of my patients ever ended up as long term bed blockers but this made my consultants look bad.

  1. Evesham man, 91, waited more than 24 hours for hospital admission https://www.bbc.co.uk/news/uk-england-hereford-worcester-61955114

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