Downstairs Patients, Upstairs!

UCEM have enlisted the help of Dr. Scott Weingart (without his knowledge of course) to improve the care of patients presenting for assessment by Waiting Room Medicine subspecialists.  UCEM’s Chair of Pedantry and resident super-genius, Professor Stickler is almost impressed by Dr. Weingart’s view that hospital geography should not determine the level of care a patient receives:

“My career goal and the purpose of this blog and podcast are to bring ‘Upstairs Care, Downstairs’ – that is to bring ICU level care to the ED, so our patients can receive optimum treatment the moment they roll through the door.”

Scott Weingart, emcrit.org

However, Professor Stickler has taken this philosophy a step further, ingeniously inverting Weingart’s philosophy of emergency care, so that even greater gains can be achieved. Thus, UCEM is introducing a new policy of ‘Downstairs Patients, Upstairs!’.

As Professor Stickler’s explains:

“I had just sent an email to Professor Andrew Wiles suggesting a few subtle corrections to his much feted solution to Fermat’s Last Theorem, when it hit me in an orgasmic wave of synaesthetic bliss like a Kekulian snake eating its own tail… I jumped straight up and out of the bath and thought to myself, “Archimedes, 11000101110102, ha!’.”

“Clearly the transition of care should not be a one way street. ‘Upstairs Care, Downstairs’ is a moderately impressive concept, but it pales in comparison to my revolutionary ‘Downstairs Patients, Upstairs!” paradigm.”

Although It may be some decades before the complete ‘Downstairs Patients, Upstairs!’ manifesto is published, UCEM have issued a press release highlighting some of the benefits of transferring patients typically treated in the emergency department straight to the intensive care unit:

  • Is your patient a really mean, sociopathic nasty piece-of-work? Or does your patient just talk too much? Well put up with it no longer… Free-and-easy employment of the endotracheal tube – aka ‘the ultimate personality improvement device’ – brings peace to one-and-all faster than a double dose of UCEM’s new Growacet pill
  • Sick of all the drunks clogging up your waiting room? Is your patient too intoxicated to be assessed by the psychiatricians? Can’t tell if its the bang on the head or the grog in the blood that’s the problem? Pop in a vascath and fire up the dialysis machine, they’ll be sober in no time.
  • Got problems with patients with gut problems? They’ve got diarrhoea and are due to travel, but are allergic to lomotil? Send them home with a rectal tube and everyone’s happy. Or, you need a stool specimen stat and the patient’s blocked through-flow is blocking the flow through the department? Give ’em a neostigmine infusion and you’ll have enough specimens to keep Prof Bristol happy for life.
  • Are your patient’s whiskers are an affront to civilized sensibilities? Once in ICU the nurses there will do what they do best: ridding the world of offensive facial hair. If Samuel Johnson was around today he would think differently about which profession is the ‘Greatest Benefit to Mankind‘…
  • Does your patient say they’ve tried everything to lose weight? In ICU they will go straight to Phase 3 of the ELF dietary plan – the ‘Sleeping Beauty’ diet. Warning: may not be effective for somnophages.
  • Does your patient have back pain and is lying around feeling sorry for himself? Get the ICU physiotherapists to work on him – they are renowned for their brutality – sorry, I meant ‘enthusiasm and efficacy’ – he’ll be up and moving in no time. And he’ll be more than happy to be on his way home.

Of course, there will be a major plus for those working in ICU too, after all, that calm and serene ICU atmosphere could do with a bit of livening up, something to drown out the machines that go bleep

UCEM welcomes any and all submissions for inclusion in the ‘Downstairs Patients, Upstairs!’ manifesto.


Utopian College of Emergency for Medicine

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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