Dave Caesar: The remote patient

Unfortunately, Daphne’s health has not been good over the last three or so years. She has suffered a number of heart problems, which has left her with an irregularity of the rhythm of the heart, feeling short of breath, and with limited mobility. On top of this, she suffered a stroke at the turn of the year that has left her with poor function of her right hand side. Since her discharge from hospital, Bill has had to care for her every day, helping with bathing, transferring and preparation of food and drink.

They remain entirely free from social services while in this arrangement, and are fiercely, and rightly, proud of this status.

As is often the case, life attempts to throw a spanner in the works, and when Bill trips while doing some gardening one Tuesday morning, the slightly precarious situation has potential to unravel.

Bill is unable to get up from the path where he fell, due to pain in his hip. He manages to crawl and drag himself back to his back door, where he can shout to Daphne to let her know he is hurt. He knows this is a bad injury, and he is able to call for an ambulance from his house phone.

The ambulance crew arrives, check that Daphne has 
access to something to drink and eat, and transport Bill to the Emergency Department at the RIE.

When Bill arrives, he is met by our triage team, who quickly realise that not only is it likely that Bill has broken his hip, but that there is also a remote patient who has just lost her main carer.

This now precipitates two streams of activity, one for Bill and one for Daphne.

For Bill, we start our newly introduced Hip Fracture Fast-Track protocol. This aims to provide rapid and consistent pain relief, X-rays, blood tests, nursing and medical assessment, as well as review by one of the Emergency Department senior clinicians and admission to a bed in the orthopaedic service, all within two hours of arrival. This requires all the components of the system (including the teams in the ED, X-Ray, and orthopaedics) to be geared up to achieve this effectively, and is being regularly reviewed to ensure compliance. It should greatly improve the experience of patients with hip fractures, of whom we see 2-3 per day at the RIE (the highest in Scotland).

Daphne’s situation is, if anything, more difficult to solve – not least because she is not present in the ED. However, we do our best to reassure Bill that his other half will be looked after while he is being treated and rehabilitated in hospital.

We rapidly contact our in-house Occupational Therapist, who has excellent links with the community services