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The importance of prompt diagnosis of broken bones

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    It is no secret that our Accident and Emergency Departments are being put under ever increasing pressure. This is set to escalate if the recent weather reports predicting four months of snow fall are to be believed. It is at this time that the NHS needs to ensure patients are cared for and treated correctly, no more so than in respect of treating broken bones. So what are the issues and what can be done to ensure an appropriate standard of care for all patients at this busy time?

    By Joachim Stanley

The latest figures reported by the Government show that the number of Accident and Emergency Department patient attendances continue to increase year on year. As the weather gets worse there is likely to be an increase in the amount of patients attending hospitals for treatment as such weather usually means an increase in the number of patients suffering broken bones!  So what does this increasing pressure on A&E mean for patients?

General patient care

The target waiting time in Accident and Emergency departments is 4 hours. Unfortunately, this target is not consistently met and it can take considerably longer for a patient to be seen. This is likely to be a frequent occurrence during the upcoming winter months and especially if the weather is as bad as predicted to be.  In my view however, patient care should always be prioritised above concerns about waiting times, and this is particularly true in relation to diagnosing and treating fractures where rushed treatment can mean compromised care.  I would much rather wait a little bit longer to be seen than be rushed through and a potential broken bone get missed and left untreated.

In these situations patients should still expect to receive proper care, whether they have fractured an arm, injured their head or torn a ligament. In every situation their injury should be appropriately examined and investigated to an acceptable standard depending on the particular type of injury.

When examining patients a doctor/nurse must always consider whether further investigations are required. This could include blood tests, a variety of scans or a referral to a specialist or specialist department. The advice or treatment given must be appropriate in the particular circumstances.

What are the potential consequences if a broken bone is not correctly diagnosed?

I and my colleagues regularly assist clients with claims relating to substandard care received in Accident and Emergency Departments across England and Wales. In many instances serious injuries have gone undiagnosed and untreated, which has resulted in significant issues for our clients.

One such case involves a client who fell from a wall and injured her left wrist. Immediately, she experienced severe pain and could not move her wrist properly. Upon arrival at A&E she was attended to by a nurse who performed a brief examination and referred her for an x-ray. However, the x-rays taken did not show images of the relevant part of her wrist and so she was advised that her wrist was sprained and was told to return home.

Our client’s wrist continued to cause her pain so she went back to A&E for further advice some months later. On this occasion an x-ray was performed on the relevant part of her wrist and it revealed that she had fractured a bone. She underwent surgery but it did not succeed due to the delay in diagnosis and treatment. She had to undergo two more operations and she has still not fully recovered and it is unlikely she will ever do so.

This is an example of an occasion where our client’s injury could have been treated correctly had the appropriate investigations been carried out. She would have avoided multiple surgeries and all of her ongoing complications. It is important that these types of failures are avoided at all costs, given the drastic impact it can have on people’s lives.

So what can be done to help ensure these injuries are not missed?

As well as a general expectation that doctors and nurses in A&E will provide the expected standard of care, we as patients can also assist.  It has been well advertised that too many patients are attending A&E for concerns that should really be directed elsewhere, such as to their GP, pharmacist or even the NHS helpline.  Unless a genuine emergency, patients are therefore being encouraged to take a moment to investigate if A&E is the right place for them to go for their particular concern.

Patients should also be patient(!) if they do attend A&E and accept that they may have to wait some time for treatment if it is not critical.

All of this can hopefully ensure that the pressure on A&E departments is reduced as far as possible and to try and ensure that patients receive treatment of the appropriate standard for their particular injuries, and avoiding or at least reducing the number of misdiagnosed injuries.

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