'I just need to find out if I had broken something or not.' A qualitative descriptive study into patient decisions to present to an Emergency Department with a simple fracture

Abstract

Background To investigate what factors contribute to a working age adult with a simple fracture seeking care in an Australian metropolitan Emergency Department (ED) Methods In this Qualitative Descriptive study, we interviewed ED patients with simple fractures including 5th metacarpal, 5th metatarsal, toe, radial head and clavicle fractures. Results We interviewed 30 patients aged 18-65. Two thirds of participants were aware they might have a minor injury. Many were well informed health consumers and convenience was the most important decision-making factor. Participants focussed on organising imaging, diagnosis and immobilisation. This sequence of care was often perceived as more complex and inefficient in primary care. ED was trusted and preferred to urgent primary care with an unknown doctor. Some patients defaulted to attending ED without considering alternatives due to poor health system knowledge or from escalating anxiety. Conclusions ED is safe, free and equipped to manage simple and complex injuries. Patients would attend primary care if comprehensive fracture management was easily accessible from a trusted clinician. To effectively divert simple fracture presentations from ED, primary care requires collocated imaging, imaging interpretation, orthopaedic expertise, and fracture management resources. Services need to operate 7 days a week and must have accessible ‘urgent’ appointments.