Prison Health Service X-ray Service

West Moreton Prison Health Service (WMPHS) provides primary health care under a General Practitioner (GP)/Nurse Practitioner (NP) led model to prisoners in correctional facilities. All patients requiring further evaluation and treatment are transferred via Queensland Ambulance Service (QAS) to Princess Alexandra Hospital (PAH).

 

Ambulance transfers from WMPHS to PAH for the past four financial years are: 742 in 2015/2016, 848 in 2016/2017, 983 in 2017/2018, and 1112 in 2018/2019. A systematic review of the common reasons for Emergency Department (ED) presentations by patients in prison done by Harel et al. (2019), highlight that up to 30% of the presentations are due to acute traumatic injury secondary to assault and self-inflicted injuries. Whereas not all injuries result in fractures, the patients have to be sent to PAH ED to rule in/rule out fractures.

 

An option to reduce ambulance transfers, ED presentations and the burden on PAH Security Unit is to establish an X-ray service within the prisons. X-rays for suspected fractures will be taken at the prisons and the images sent via PACS to PAH radiology department for formal reporting. For soft tissue injuries and for a set number of simple fractures that fit the virtual fracture clinic, treatment/management will be provided by the GP/NP locally and appropriate referrals will be made where applicable. All other fractures requiring specialist review will be sent to ED for further evaluation/treatment and referral to Orthopaedic department. Some advantages of doing X-rays at the prison prior to transfer to ED are: reduction of time that the patients spend in ED, and streamlined patient flow through ED.

 

 This model will enable patients to receive treatment locally using a model adapted from the virtual fracture clinic to manage specific fractures. Virtual fracture clinics have been operating successfully for several years in the United Kingdom and here in Australia with plenty of research to support their efficacy (Logishetty 2017, Evan et al. 2018, McKirdy et al. 2017, Brogan et al. 2017).

 

There is potential to use other point of care testing models to minimise transfer of patients to ED.

Why the contribution is important

  1. Reduce ED transfers
  2. Treat patients closer to home
  3. Minimise the time patients spend in ED
  4. Reduce costs associated with transferring patients to hospital
  5. Reduce infrastructure strain at the PAH Security Unit

by winanis on August 12, 2019 at 03:16PM

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Average score : 5.0
Based on : 2 votes

Comments

  • Posted by stojskit August 16, 2019 at 10:26

    Great idea. This would not only reduce potentially unnecessary presentations, but also be a cost saving measure should transfers occur less frequently.
  • Posted by miked August 20, 2019 at 16:30

    This would also reduce the cost associated with the prison services having to pay for 2 guards to present to ED with every patient. Services are left with guard shortages due to the number of guards sitting in ED with prisoners, requiring added staff to be called in whilst on call or staying on at the end of their rostered shifts.
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