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>
I think this is one of the problems with a system of direct admission
to
the
> wards especially when it is performed by junior A&E
doctors. Sometimes
patients
> won't have had the appropriate tests or
treatment in A&E and thay may not
be
> seen for hours on the ward
to have this rectified. A recent study in the
region
> has suggested
that patients with #NOFs who are fasttracked do worse than
patients
>
with #NOFs who spend longer in A&E.
You know, this doesn't surprise
me. I've always wondered why many people
consider fast-tracking of #NOFs to
be such an important quality issue or
performance indicator. Of all the
patients we see, surely these patients are
among the least acute...yes they
need sorting out for humanitarian reasons,
and early management will
marginally influence morbidity and mortality, but
they do not have an
immediately life-threatening illness and they are not in
the same league as
acute MI patients, for example, or any patient with
physiological
derangement in the resus room. For #NOF patients analgesia and
a
comfortable bed are important, fluids are more debatable as most of
these
patients are euvolaemic, but rapid admission to an orthopaedic ward
seems a
perverse measure of quality - orthopaedic wards are decidedly
dangerous
places to be if you have a chance of having a serious medical
condition. Who
dreamt up this performance indicator? If an indicator were
needed, surely it
should be time to surgery, especially where ORIF is
carried out on
intracapsular fractures where delay equals avascular
necrosis. But hey - I
don't want to step on the orthopods toes
again!
Adrian Fogarty