crisis Room Care at Home

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Hospital emergency departments (Eds) were initially designed to supply immediate care for patients experiencing acute medical conditions and serious trauma victims. Once patients were stabilized they were either discharged home or transferred to other location for more industrialized and specialized care. Now, Eds are experiencing increased use by people who do not have a former care supplier and use the Ed for habit medical care. The increased inappropriate usage of the Ed places an increased stress on already strained healthcare resources.

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Eds have responded to the increased usage for non-emergent services by gift many more resources than the former emergency room. Now the Ed has more diagnostic and medicine options than were previously intended. The Ed now is a self-sufficient unit within the larger medical center, and has become integrated into the patients' continuum of care. In-house specialty consultations are usually immediately ready as are industrialized diagnostic studies. This has possibly led to a perpetuation of the misuse of the modern day emergency department.

An increasing qoute is the misuse of emergency services by patients who do not have a former care supplier and use the Ed for habit and non-urgent care. Less than 10% of emergency room visits are honestly emergencies. More than half of the patients that present to the Ed could be great served by being treated in place (home, skilled nursing facility, occupational health office, or added on to a Pcp schedule). One-third of Ed visits could be treated in a former Care supplier office. It has been well established medicine in emergency Departments is more costly than in any of the above mentioned inherent care settings.

Despite the high cost of Ed services non-emergent use of emergency services continues to grow. Many non-urgent Ed visits could have been avoided if patients had a pre-existing connection with an accessible former care provider. In increasing to the financial cost, crowded waiting areas, long wait times, actual and inherent delays in receiving medical care patients are subjected to increased risk for medical errors, exacerbation of pre-existing conditions, and nosocomial infections. Ers will be swamped in the middle of the flu season with a compound of sick person types some with actual flu or swine flu while others have minor sprains. Now the someone with the sprain has been exposed to the very contagious flu.

The medical house call has started to make resurgence in many parts of the country to help address many of the former preventative non-urgent care needs of patients. The mean Ed visit in Nyc can cost upwards of 0 and brings with it the risks of medical errors due to many separate health care providers, loss of work and wages due to continued wait times, and infectious disease risk due to the gathering of people with airborne illness (Influenza, H1N1, staph and strep infections).

The mean cost of a medical house call in Nyc ranges from 0- 0 and greatly reduces the risk of nosocomial infections, saves time and reduces lost wages because the sick person is able to wait in the relieve of their own home. Often times being able to see the patients normal environment can supply many clues for diagnosing a health at a fraction of the cost of the Er visit. One hospital in Connecticut has even gone to posting wait times on line for their Ers so patients can log on and see how long it will take to be seen. As much as policymakers say they would like to reign in cost of health care clearly some have decided if you can't fix the qoute you may as well feature the problem.

The modern day medical house call can now offer many of the same services that were once only ready in the emergency room. In the modern day medical house call patients can have ample bodily exams that contain blood work, Ekgs, x-rays, and ultrasounds (cardiac echo, carotid Doppler studies etc). These tests are often adequate to supply the needed data to make a diagnosis and institute a medicine plan. other advantage of the medical house call is the clinicians that are finding you are able to give you their undivided attention. Also you will be able to see the same health care supplier as opposed to the physician of the day or medical resident. other advantage of the medical house call is the increased privacy that you are afforded by the nature of staying in your home. If sick person use the medical house call for their former care needs as well as their sick day needs they may be able to spare themselves the stress and risks of a trip to the emergency room.

Some coarse conditions that can be treated in the home contain coarse pulmonary infections (pneumonia & bronchitis), gastrointestinal conditions (stomach flu & abdominal pain), dermatological conditions (2nd degree burns, acne, rashes), chronic conditions (diabetes, Copd, hypothyroid, obesity, congestive heart failure, high blood pressure), urological problems (urinary tract infections, prostate inflammation, kidney stones), and dehydration. One preventative care portion that can be done in the home that is not typically done in an Er or even a former doctor's office is health behavior counseling for lifestyle modifications. Typically this is done in doctor's offices and emergency rooms by giving you a generic handout. The guess for this is because the former care environment is focused doing the least number of care inherent to meet the needs of the masses that are waiting to be seen.

Emergency rooms were initially designed to treat acute medical conditions and to stabilize trauma patients before they are transfer to the standard medicine location. Unfortunately, Eds have also become a place to seek medicine for many people who do not have a former care provider. As a result, the numbers of emergency visits has increased, although the reasons for the visits are often not emergencies. Non-emergent visits are causing a huge backlog of real emergency patients and increasing the number of money spent on healthcare.

A new medical house calls firm in Nyc has recently opened which allows patients to delineate with their Pcp online via a acquire sick person portal. Patients can ask appointments online. The Nurse Practitioner arrives at the patient's home, office or hotel usually the same or next day. The Np can diagnose the problem, order tests (most of which can be done at the patients home) and electronically submit a prescribe to the local pharmacy that can typically deliver the medication. The firm also offers established patients the convenience of web-cam follow-up appointments and email consultations, which allows patients to take their former care supplier with them when they travel. All of this costs a fraction of what the starting price of an Er visit would be. Patients can use their flex spending and health savings accounts or major prestige card to pay for this service. As the moot over health care continues more and more innovative and store solutions will talk the call to solve the nations health crisis. The qoute will be if course is made to stifle innovation.

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Thomas Russell & The Early English Watchmaking Industry

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Thomas Russell 's name is synonymous with the Lancashire watch making industry and he is an icon for watch purists and enthusiasts around the world. But how he came to become a watchmaker and why Lancashire played such an important role in the watchmaking industry is a fascinating story.

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In the 17th century farmers and agricultural workers who needed to supplement their income during the winter months undertook much of the work of watchmaking. In and around Lancashire this was particularly important and the proximity of metalworking, the availability of fine metal tools and the port of Liverpool aided the growth of the industry. By the 18th century watch parts were being sub-contracted to small farms and cottages throughout the region.

Another factor in the growth of this cottage industry were the significant lower overheads that the farmers enjoyed as part-time workers in their own homes. Elsewhere wages were the largest contributor to the total cost of watch manufacturing with the cost of raw materials, apart from gold and silver used in the making of expensive cases, relatively small.

One commentator notes that, "From Prescott to Liverpool, eight miles as the crow flies, the countryside was dotted with the cottages of spring makers, wheel cutters, chain makers, case makers, dial makers - every speciality that went into the making of a watch." By the end of the 18th century between 150,000 and 200,000 watches a year were being produced by this system, satisfying the national need for accurate timekeeping as the industrial revolution took hold.

The Lancashire sub-contracting system allowed the production of watch movements at such low prices that by the end of the 18th century, the Lancashire manufacturers were supplying most of the great watch firms in London, Coventry and Liverpool. All that these firms needed to do was to make or source their own case and dial, and then assemble the watch.

Thomas Russell joined this hive of activity in 1848 when he moved his business as a watch manufacturer to Slater Street in Liverpool. The city was a major seafaring port and the manufacture of ships' clocks and chronometers became an important revenue stream for the business.

Thomas Russell's father, also named Thomas Russell (1780-1830), the founder of this watchmaking dynasty, was born in Eskdale a small village in Cumberland. He served his time in watchmaking in New St. Broughton-in-Furness Lancashire under William Bellman, he then served his journeyman time with William Wakefield in Market St Lancaster where he later started a business of his own in the same street.

He had two sons; one named Thomas was married to Mary in 1831. They also had two sons, Thomas Robert (1833-1894) born in Lancaster and Alfred Holgate Russell (1840-1893). In about 1840 the family moved to Halifax setting up a watchmaking business in Lord St. It was here that Alfred was born.

By 1848 the family had moved once more and records show that Thomas Russell was a watch manufacturer with premises at 20 or 22 Slater Street, Liverpool and later at number 32 in the same street. It was here that Thomas Russell became arguably Liverpool 's finest watchmaker and the business produced quality watches and clocks, including the celebrated Russell Hunter pocket watch. Thomas Senior and his oldest son Thomas Robert were granted a Royal Warrant by Queen Victoria indicating their rapid progress in watch manufacturing.

Around 1859, Thomas handed over control of the business to his sons Thomas Robert and Alfred Holgate and the company changed its name to Thomas Russell & Son. Following Thomas Russell's death in 1867 the business was divided into two; the trade side continued under the same name and was run by Alfred and Thomas ran Russells Limited. The retail business became importers of Swiss watches and music boxes.

By 1877 the company had moved the business once more, this time to Cathedral Works, 12 Church Street, Liverpool, with additional offices at Piccadilly in London and Toronto, Canada. It was now known as the Russell Watch and Chronometer Manufactory and was listed in 1880 as "watch and chronometer manufacturers and machine made keyless lever and jewellery merchants" and additionally, "by Appointment to Her Majesty the Queen and HRM the Duke of Edinburgh and the Admiralty".

After Queen Victoria's death, Thomas Russell still signed their watches "Makers to Queen Victoria" even though officially the warrant had ceased with the Queens death. This was tolerated for a time before they removed this from their watches.

Following the deaths of Thomas Robert and Alfred Holgate, Alfred's son Bernard Holgate Russell and his cousin Thos Townsend Russell took over the company and the name of the business was changed in 1894 to Russells Limited. From this date it appears that they continued as retail jewellers with several branches in Liverpool and, by the early 1900's, Manchester and Llandudno as well.

Bernard married and had a son Thomas Graham (1906-1999). In 1915 Bernard and Thos Townsend Russell invited Joseph Wright to become a fellow director of Thos Russell & Son. Joseph had extensive trade knowledge, travelled extensively and had business contacts in Switzerland and working experience with the famous American Illinois Watch Case Co.

The sons of these directors all seemed to have worked in and run the business in later years. During WW2 Joseph Wright kept the firm going despite wartime shortages of materials and men until the sons returned from the war. In about 1994 both the retail Liverpool Russells Ltd and the workshops and offices at 12 Church Street closed their doors for the last time.

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