Objectives-To determine whether the mentoring scheme currently used has an impact on the training of senior house oYcers and also determine if they are willing to accept middle grade mentors. Methods-A questionnaire comprising 10 questions was sent to all the senior house oYcers employed in the emergency departments of two large inner city teaching hospitals and three large district hospitals. Most of the questions required a simple yes/no response. Results-Most of the senior house oYcers had mentors allocated to them but felt the scheme was not satisfactory probably because they had low expectations. Most were happy to have middle grade doctors as mentors. Conclusions-Senior house oYcers have a low expectation of the present system and seem willing to accept middle grade doctors as mentors.
A 16-year-old male with a simple but dirty wound over the right cheek. B 23-year-old female with a complex wound to the lower lip. C 65-year-old male with an extensive laceration to the forehead. RESULTS There was a 76% response rate. Suturing was the preferred method of closure, with the majority of clinicians preferring 6/0 or 5/0 non-resorbable sutures. Use of a regional nerve block would be considered by a quarter of clinicians, and adrenaline vasoconstrictor by a third. Referral rates ranged from 5-77% for a more complex wound. Maxillofacial services were preferred by 51% of respondents; on-site referral availability was indicated by only 28%, with an average journey of 16 miles for treatment. Up to 30% of clinicians considered prescribing antibiotics after wound closure, with flucloxacillin and co-amoxiclav most commonly suggested. Accident and emergency review rates ranged from 16% to 45%, with most wounds either being referred to the GP or no formal review being suggested.
EMERGENCYCONCLUSIONS The results of this survey suggest that there is considerable variation in the initial management, referral and review of facial wounds in the UK. Further work is required to formulate guidelines for optimal patient care, ideally in conjuncture with the receiving surgical specialties.
there is an increasing demand for emergency health care and our population is older. The effect of this would be to lessen the strength of our findings.Our approach seems to largely work for us. Clearly, local adaptation is necessary for different hospitals. Very few hospitals are of our size and have the range of our services on site. Whether the benefits that we have identified are transferable to smaller hospitals is not clear.
CONCLUSIONCombining all emergency care into one place has significant advantages in reducing admissions to hospital and the length of stay of admitted patients. It may be associated with a decrease in formal complaints and clinical incidents, but this system places a hospital at a financial disadvantage. The system needs testing in a range of settings to establish whether this is truly externally valid.
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