A Simple Colles Fracture

Falls are well researched and well documented.

We know alot of information about the “why” people fall and the consequences of a fall. 1 in 3 people over the age of 65 experience a fall in a 12 month period (Lord et al 2009). 50% of falls in community dwelling elderly occur in the home with the remainder occurring in remainder in public spaces. Those who present to an Emergency Department are likely to fall again. This is one place where a faller should be targeted. But the emphasis on Emergency Medicine is get them in, get them out. And I agree. Having worked for 7 years in an Emergency Department I strongly believe they are not the place for extended stays. But a time limit makes it difficult to provide the most appropriate treatment for every patient.

A broken wrist on a 16 year old is and should be treated differently to a broken wrist on a 76 year old. Funding or KPI’s should not be diagnosis based or category based it should be case mix/complexity funding.

A 76 year old presenting to an Emergency Department with a broken wrist needs 2 things.

1. Definitive management – this being in the form of surgery – Yes or No – and immobilisation. They are the easy things

2. Follow up – they need a place to go for further assessment. They need someone to talk to them about Osteoporosis risk, falls risk and further prevention.

Our health systems have done 2 things. Firstly they provided provided patients with access to specialty aged care teams in the Emergency Department who can identify these clients ongoing risks, provide them with appropriate information and complete the assessments and provide appropriate referrals to community services and further allied health intervention. This can make someone safe to leave the Emergency Department and also to prevent hospital admission. Think saving BED DAYS and SAVING MONEY. And by doing this the important task of Life Saving Medicine has been left to the ones who do it best. The ED staff are not spending their time determining safety of discharge or putting on plasters. They are free to continue to manage the acutely unwell patients . However in doing this, by providing access to such skilled individuals, increases the time a patient is in the department. But we can’t have it both ways.

I do believe the ED isn’t the place to be completing such detailed complex interventions. However when resources are limited in the community or in aged care or allied health departments you need to be able to provide this service. If you want to get patients in and through Emergency Departments you don’t need to increase the number of beds (in isolation of course – If no one ever waited on an ambulance stretcher that would be fantastic) or hugely increase staff (again in isolation) we need to improve the rest of the pathway or divert people from attending in the first place. When there are no beds ED’s don’t flow. When there is no X-Ray or blood path reporting you can’t flow patients through the department. These all create blocks and unfortunately the ED is the department that is affected by everyone of the blocks. Every challenge faced across as hospital blocks the ED. And until the whole process is looked at it will never work smoothly with all parties – patients and staff – working harmoniously together.

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