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> > Our physicians have decided they will no longer take > > patients with fractures unless the fracture is > > secondary to a medical condition that needs sorting. > > So simple falls with pubic ramus fractures in elderly > > or patients with Colles fractures admitted because > > they live alone and can't cope are being sent to > > orthos now! I'm standing back to watch the fireworks! Fine as long as the orthos take them. Otherwise the patient and the A and E department are caught between interdepartment pettiness. > Not > only do they take > pubic ramus fractures and colles fractures (clearly medical > conditions!?) The other side of it is that pubic ramus fracture and Colles' fracture are outpatient conditions (unless Colles' fracture is in a patient unsuitable for day surgery). If the patient requires admission it is because of one or more medical conditions. If you put a patient with undertreated or undiagnosed Parkinsons, small PEs, cardiac failure or hypovolaemia on an ortho ward they'll mobilise slower than if admitted under a good general physician. > Pretty soon, I bet > they'll be taking > head injuries because the local surgeons aren't trained in > the management of > head injuries. I hope so. General physicians do seem the best placed (apart from possibly neurologists or neurosurgeons) to have the skills (experience in long term care of brain injury, experience in care of fits/ epilepsy, experience of proper observation medicine, diagnosis and treatment of non specific neurological disorders, outpatient follow up) too look after head injuries not needing surgery. It always seemed that the admission under surgery (or A and E as a branch of surgery) was based on historical precedence (the single surgeon doing everything) rather than the needs of the patient. > As a GP, I'd like to endorse your comments. I would be > more than happy > if my patients (inapropriately attending A&E) were diverted > back to me. > Those that do attend (in my experience) have done so of their > own accord, > often against GP advice. This accords with my experience. There are a lot of patients who say they were told to come by their GP or that their GP had no appointments with whom investigation reveals that the GP had free emergency slots that day. It is odd (but true) that some patients will come to A and E because their GP won't visit. Redirecting patients to other health care providers is good medicine. Can generate a bit of bad feeling if done by the doctor after the patient has been waiting 6 hours (or 75 minutes in the new NHS), so ideally done from triage, but even if done by the doctor it is useful (public education: a dissatisfied customer tells and average of 10 people. Use this to your advantage). Use of a sensible triage nurse empowered to act professionally and discharge outside protocols is probably the best way forwards (although Stoke experimented with consultant triage and sent away about a third); but local adaptations of the Coventry guidance would be a pretty good start. The difficulty is in persuading staff that just because a patient comes to A and E you don't have to treat them. Matt Dunn Warwick This email has been scanned for viruses by NAI AVD however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust unless explicitly stated. If you have received this email in error, please notify the sender.