You both have valid points. I agree with Andy that it makes sense being
"strategic" about these matters. Seeing a Colles fracture at Day 1 post-ED
is a bit of a wasted slot as the position is unlikely to have slipped from
Day 0. Makes more sense to see that patient on Day 7 when it can be
corrected if it has moved, or forgotten about if it hasn't. And wasted
fracture clinic slots just add to the overall waits for all.
But I also see Rowley's point. SHOs are not very good at such "strategic"
decisions when it comes to fractures - nor for that matter are many
modern-day middle-grades, who are excellent physicians but lousy surgeons
for the most part (no offence). We can't rely on SHOs to distinguish what is
urgent and what is not when it comes to fractures.
However, it seems to me that getting all fracture patients seen "within the
week" satisfies both camps and both arguments, most of the time. The
exception might be the epiphyseal fracture, which unites with alarming
rapidity, being quite resistant to manipulation within a matter of days from
injury. A solution might be one rule for children; another for adults.
AF
----- Original Message -----
From: "Andy Webster" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, July 19, 2006 8:25 PM
Subject: Re: Fracture clinic time scales
> There are actually more patient episodes, because the colles will get seen
> next day and at one week to check position in cast has not moved.
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
> Sent: 19 July 2006 20:11
> To: [log in to unmask]
> Subject: Re: Fracture clinic time scales
>
>>should we get all the
>> patients they see followed up by someone else...GP, medics, surgeons
>> etc?
>>
>> Andy Webster
>>
>
> It certainly fits in with the one stop shop philosophy.
>
> I don't know if you are deliberately missing the point, Andy, but
> sometimes our SHOs don't ask our advice, and sometimes they do get it
> wrong. Bones can be remanipulated when you like and as you like, but you
> may like to reflect on the message sent to the patient by huge delays.
> They aren't needed, after all. The same number of patients eventually
> get seen whether it is the next day or two weeks later.
>
> /Rowley./
>
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