ABSTRACT
Buckle fractures of the distal radius are unique to children and a frequent presentation in the emergency department (ED). In University Hospital Waterford, Ireland, the treatment of buckle fractures followed the traditional method involving a rigid cast and a follow-up hospital appointment. However, the latest literature indicates that buckle fractures are stable and heal without complication, so a minimalist approach to treatment is recommended. Therefore, the advanced nurse practitioners in the ED introduced a change in protocol at the hospital. This involved the use of a soft cast for removal at home, with verbal and written discharge information and no follow-up appointment. An audit was conducted to ensure that this new protocol was safe and effective, and the time and distance saved by patients through avoiding a return hospital visit was estimated. Treatment in a soft cast with verbal and written discharge information revealed a successful outcome for all 88 patients included in the audit. Avoiding return hospital visits resulted in significant travel time and distance savings for patients and families.
Subject(s)
Bandages , Emergency Service, Hospital , Fracture Fixation/methods , Radius Fractures/nursing , Adolescent , Casts, Surgical , Child , Child, Preschool , Device Removal , Female , Humans , Infant , Ireland , Male , Nurse Practitioners , Quality Improvement , Radius Fractures/diagnostic imagingABSTRACT
UNLABELLED: Emergency Departments (EDs) worldwide are facing a crisis from overcrowding and a common perception exists that inappropriate use of the ED is a major contributing factor. Patients, who attend the ED with non-urgent problems, could be dealt with by a General Practitioner; such patients use time and resources that would otherwise be used for patients with more appropriate needs. STUDY AIM: To explore attitudes and perceptions of healthcare providers regarding 'inappropriate attendance' in the ED. STUDY DESIGN: Using a survey questionnaire, this descriptive quantitative study included ED nurses, doctors and paramedics from three regional hospitals in the Republic of Ireland. RESULTS: A total of 163 surveys were returned (59% response rate). There was an overwhelming agreement among respondents that inappropriate attendance in Irish ED exists and poses a considerable challenge for healthcare providers. Results suggest differences of opinion on what represents inappropriate ED use. Potential solutions to address the issue of inappropriate ED attendance include General Practitioners and Advanced Nurse Practitioners practicing within the ED setting; education and greater public awareness and faster access to a specialist opinion in the Out Patient Department.
