Fracture incidence in England and Wales: a study based on the population of Cardiff.

Despite the importance of fractures as an economic and health problem, and consequent interest in osteoporosis, few workers have previously attempted to define the overall incidence of fracture. This population based study was based in the Accident and Emergency Department of Cardiff Royal Infirmary and identified all patients presenting with fractures of any type. Over a single year a total of 6467 fractures were identified among the 306,600 people who live in the city of Cardiff. This gives an overall fracture incidence of 21.1/1000/year, (23.5/1000/year in males and 18.8/1000/year in females); a result very similar to those from similar work in the USA, Australia and Norway. This result is over twice the previous estimate of fracture incidence in the UK; the figure of 9/1000/year from the only equivalent study performed since the 1960s. In part, this discrepancy appears to reflect our more rigorous definition of the study population, and our improved ascertainment of minor fractures. We believe our result to offer the most accurate estimate of fracture incidence currently available for a UK population.

The nursing triage process: a video review and a proposed audit tool.

OBJECTIVE: To review the activity of the nurse triage process. SETTING: The triage room for adults attending the accident and emergency department of the Cardiff Royal Infirmary. METHODS: 226 triage processes were videotaped over 31 h during July 1994. Activities were subsequently analysed using a specially designed chart. RESULTS: Areas for improvement in staff communication skills and patient privacy were identified. CONCLUSIONS: The use of video in the triage room allows assessment of the triage process and is a valuable aid to training. Additionally, a potential visual audit tool has been identified.

Senior house officers' work activities in an accident and emergency department.

A study of senior house officers' daytime work activities was conducted in the accident and emergency department of the Cardiff Royal Infirmary. Activities were timed every 15 seconds by a single observer and were subdivided into working periods, meal periods and periods when no patient was waiting to be seen. A total of 96.1 h was analysed. The SHOs were found to be working for 78% of their time, of which 18.5% was taken up by non-doctor tasks. The SHOs took an average of 10.4 min for each walking wounded patient, 10.6 min for each paediatric patient and 27.3 min for a trolley patient. Each patient required an average of 14.2 min for assessment and treatment, which meant that 3.3 patients were seen each hour. However, considering that SHOs worked for 78% of their time, the actual rate of work was 4.2 patients for each working hour. The implications for staffing are discussed.

Victim as offender in youth violence.

STUDY OBJECTIVE: To determine how often adolescent and young adult victims of assaultive injury are offenders in assaults and other crimes. DESIGN: Comparison of 10- to 24-year-old males treated in the accident and emergency department for assault-related injuries to similar-aged males treated in the same department for unintentional injuries. Police records were searched on both groups for warnings or convictions. SETTING: Accident and emergency department of the Cardiff Royal Infirmary. RESULTS: Assault patients were significantly more likely to be formally warned or convicted, and they had a higher mean number of warnings or convictions per 100 person-years of exposure, than other injury patients. These differences were most pronounced for the younger patients and for the year following the injury. CONCLUSION: These results suggest that many young male assault patients either have a history of criminal activity or develop criminal behavior subsequent to their assault and may benefit from appropriate intervention aimed at interrupting the cycle of crime and violence.

Telephone advice in the accident and emergency department: a survey of current practice.

The objective of this study was to assess the standard of advice given by telephone by accident and emergency (A&E) departments following patients' enquiries. In order to do this patient enquiries were simulated and a telephone questionnaire was carried out. The study was carried out in 18 major and 16 minor A&E departments in Wales. Results achieved were that overall, correct telephone advice was given to 72 of 97 simulated patients (74%). Sixty calls were dealt with by the nursing staff (62%) who gave correct advice on 41 (68%) occasions. No A&E department had a formal policy nor provided staff training for handling patients' enquiries by telephone. It is concluded that A&E departments should train designated members of staff, preferably the triage nurse, who would formally deal with telephone enquiries requiring medical advice. There should be formal documentation of the enquiry and advice proffered as part of a departmental policy.

A review of displaced olecranon fractures treated conservatively.

Twenty-two patients with a total of 23 fractures of the olecranon were reviewed after an average period of 26 months (range 5-96 months). All fractures were either comminuted, transverse or oblique fractures with separation of the fragments and all were treated without operation by early active mobilization within 10 days of fracture. Results compare favourably with cases treated by operation.

Complaints and litigation--three years experience at a busy accident and emergency department 1983-5.

Between 1 January 1983 and 31 December 1985, 72 complaints concerning the management of patients attending Accident and Emergency (A & E) Departments in South Glamorgan were received. This represents an incidence of 1 in 3,390 new patient attendances (0.029%). Thirteen cases have to-date involved legal action (1 in 22,895 new attendances). An analysis is made of the nature and management of these cases.

Children's car-restraints: use and parental attitudes.

An analysis of the attitudes of 600 parents towards children's car-restraints together with their use is presented. Only 47% of infants under 9 months of age and 26% of children under 15 years of age were always appropriately restrained. Children under 4 were more likely to be restrained than older children and previous involvement in a road-traffic accident led to increased use of restraint.

Non-accidental injury--the adult problem.

In November 1986, 141 people attended the Accident and Emergency (A and E) Department of the Cardiff Royal Infirmary as a result of deliberate violence (assault). This represented 2.3% of new attendances at an estimated cost of pounds 10,591 for investigation and management. The workloads imposed on A and E Departments and the financial burden on the NHS are considerable.

Improving facilities for children in an accident department.

A separate waiting and treatment area for children was established within an existing general accident and emergency department at relatively little cost. We describe how this was achieved and how it has benefited the children attending the department.