"Physiotherapist assessing broken bones in the ED"

About: Royal Melbourne Hospital / Emergency Department

(as the patient),

I fell backwards onto my hand on a concrete floor, by the pain I knew it was broken.

For decades I have praised Royal Melbourne Hospital (RMH) to people, I think they do a fantastic job and have seen no other hospital cleaned so thoroughly, but, this day I went straight to RMH emergency with a badly broken wrist.

Very soon I saw a Physio who arranged an X-ray and put a half plaster on my arm. I was informed how to care for arm and I asked for a sick certificate. The Physio said they'd give me only 3 days, then sent me home advising I will get an appointment by text, which I did for the following week.

I turned up for appt and was sent to plaster room for full plaster, from there told to go to X-ray, then straight home, don't come back here and if there is a problem you will be notified.

So two days later, I got an appointment date for nearly another week's time, went to the appt and finally saw a doctor almost 2 weeks after the accident. I was told my wrist is mangled and it may be too late to set it straight and that normally the doctor can set it well if seen soon after the break, but I may be able to get an operation and a plate put in at this late stage.

Why didn't I see a doctor in Emergency? I would be happy to wait all day and night to see the right person and not suffer what I believe may be a disability for the rest of my life.

Responses

Response from George Braitberg, Executive Director Strategy, Quality and Improvement, Melbourne Health

picture of George Braitberg

Dear Happywanderer,

Thank you for your feedback. As you can appreciate without knowing specific details I can only provide general comments and information. Firstly let me express my apologies if you feel that you haven’t been cared for appropriately at RMH.

The process you have described is now routine for the management of uncomplicated fractures. Our Emergency Department (ED) has specially trained primary practice physiotherapists who work under the supervision of emergency doctors and can make independent assessments of injuries to muscles, tendons and bones. They are appropriately qualified to provide care in the ED. Depending on the injury a full or half cast may be applied. It is not uncommon to apply a half cast initially to allow for swelling.

For the past 2 years, we have introduced an innovative (and award-winning) program called the Virtual Fracture Clinic (VFC) to reduce the waiting time for our patients in clinic. In RMH’s VFC, all fractures are reviewed by consultant orthopaedic surgeons, although our VFC coordinators (who are physiotherapists) co-ordinate the care that is advised by the surgeons. In this model, our physiotherapists provide the information to the patient but the X-rays and management plan has been reviewed and approved by our orthopaedic doctors.

It would seem that the team has not adequately explained the process to you leading you to conclude that a doctor was not involved in your care until the 2-week review. I hope that my detailed explanation has corrected this, and apologise if this was the case.

With respect to the outcome of your fracture, all Xrays are reviewed by an orthopaedic specialist as explained above. Unfortunately, some fractures do slip even in plaster and I suspect this may have happened.

If you would like to follow this up further could I ask that you email our Consumer Liaison Office with your details? Their email contact is consumerliaison@mh.org.au.

Regards,

Prof George Braitberg AM

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