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Taking the drama out of kids' visits to A&E
Buy this photo » Callum Davies in the waiting room
WALKING into the emergency department of the Great Western Hospital is a daunting experience for any patient, especially a child.
As part of our Making it Better appeal to raise money for the new department, reporter Matthew Edwards followed the patient pathway through the department.
He was assisted by 12-year-old Callum Davies who, for the purpose of the story, had suffered an arm fracture after falling from a tree.
First step: Triage. After entering the department, Callum was seen by the receptionist where his personal details were taken and he was asked to take a seat in the waiting area before being called in.
A staff nurse in Triage is the next member of staff a patient will see to determine the priority of treatments based on the severity of their condition.
Every patient is given a CAS card, which is put in a tray for the staff nurses to take in time order.
A responsible adult will always be in the room while a child patient is asked questions by the nurse. The patient is also weighed and any pain relief that is needed at the time is administered.
The area where the patient is complaining about pain is then assessed and the decision is made whether or not to give them an X-ray.
If it is suspected that there is a break or a fracture then the patient is given an X-ray card and advice form before the injured part of the body, in this case the arm, is put in a sling.
Staff nurse Leoni Monet said: “It is more difficult to assess children because they have different pain thresholds, whereas an adult might make it clear where their pain is, children would say the pain is all over, so it is important that we make sure exactly what the problem is as soon as possible.
“We have a number of nurses that are dual trained for paediatrics and adults, which is a good thing, but we all have to deal with children and it is about coming down to their level and making sure they feel as comfortable as possible.”
Second step: X-Ray. After following the red signs to the X-ray room, patients wait in a small waiting room to be seen by the radiographer.
An X-ray is a safe and painless procedure often used to produce images of the inside of the body and is an effective way of looking at fractured bones, such as a broken arm or wrist.
During an X-ray the patient is asked to either lie on a table or stand against a flat surface so that the part of the body, in this case the arm, is positioned between the X-ray machine and a photographic plate. It will last for a fraction of a second and as the X-rays hit the photographic plate, the plate captures a snapshot of the image. The resulting image is then transferred to a computer so it can be studied on a screen.
If there are any abnormalities then a red dot is put on the card so the doctors are aware.
Emergency department superintendent radiographer Rachael Hilton said: “Treating children is different depending on the child’s age.
“Most would follow the instructions but the younger they are or the more pain they are in it is difficult, but there is always an adult in the room with them.
“We do see an increase in child patients during the school holidays especially in the first week after the children break up.”
Third step: Doctor. Once the X-ray is completed, the patient returns to the waiting room before being seen by a doctor, who carries out three checks using the acronym LFM – Look at the injury and the results of the X-ray, Feel around the area checking where there is pain and then check how much Movement there is in the area of the injury.
If the doctor thinks there is a break or a fracture they liaise with the orthopaedic department and organise an appointment for a cast.
In this case, the arm would be put in a half cast and then three or four days later, the patient would return for a full cast.
The injury would take approximately six weeks to heal.
Emergency department doctor Ian Robertson said: “Everyone who gets an X-ray then goes through an examination.
“When we deal with children we try to treat them the same as an adult, but we try to be more friendly and talk to them at their level because they can be quite quiet and hard to get the right information out of.
“I think the environment the children are treated in will definitely be improved by the new department.”
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