Comment 19234

By Ted Mitchell (registered) | Posted February 24, 2008 at 20:21:12

anonymous, your concern is in the right place but you are considerably overestimating the benefit of a dedicated paeds emerg / hospital and underestimating the harm done to adult medicine in west hamilton.

Children who cannot be cared for at Mac are very rare, and fall into two categories: 1.really complicated ones who need to go to Sick Kids anyway , and 2.children who can be treated locally but lack enough resources as in beds, staff.

wrt 1, why try to compete with a world class children's hospital that is so close to Hamilton, it's a losing concept. as for 2, there are much easier and less harmful ways to accomplish this than wiping out adult medicine at Mac. Mac is already an excellent children's hospital, and referral support, rather than physical infrastructure,is the critical need. Mac will always need to respond to referrals from small peripheral hospitals, such as the one I work in , and from family docs all over the city, so why not also a few more from other ERs in Hamilton? This is a problem of facilitating consults and it is the primary problem as far as quality of care is concerned, independent of anything they do to the physical infrastructure. I fear this problem will not be addressed as admin will be too mixed up in vacuous rhetoric about centres of excellence while they ignore real problems.

The proposed "emerg" in west hamilton is really a walk-in clinic with some testing capability. Triaging is a nightmare in such facilities, and there will be considerable obstruction to necessary transfer to bigger centres. The more capability this facility has, the greater these referral problems. I'd like to do this kind of work, but it is medicolegally risky, not to mention unpleasant wrt begging consultants to see someone, which also means physical transfer, and by what mode? Can of worms...

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