Planning and partnership pivotal to after-hours care

A Townsville University Hospital emergency department (ED) doctor and local GP are shining a light on how emergency departments and GPs work symbiotically to care for the community after hours.

Cranbrook Medical GP Dr Toni Weller said while people attending emergency departments out of hours was sometimes unavoidable, there were easy steps people could take to stay out of the ED.

“With many chronic health issues there are certain triggers and you may be able to anticipate when your condition is about to worsen,” she said.

“If you have asthma, you can go to your GP and create an asthma action plan.

“If you have diabetes and a wound is not healing, make sure you see your GP before it gets infected.

“Work with your GP to make a plan for what happens on your worst days; that is a good start to avoid an unnecessary visit to the emergency department.”

Dr Weller said she encouraged people to be proactive with their healthcare.

“Being proactive often means people don’t end up so unwell that they require an ED admission after hours,” she said.

“Doing things like having regular, pre-booked appointments with your GP can be so helpful.

“It allows people to raise issues of concern, before they become acutely unwell, and do things like ensure they are up-to-date with scripts for medications. “

Dr Weller said there were other benefits to having a trusted, regular GP.

“If you have a relationship with a GP, they may be able to also offer some telehealth appointments,” she said.

“Medicare legislates that you need to have seen your GP face to face in the past 12 months and have an existing relationship to do a telehealth appointment.

“This can come in handy for people who might not be able to come into the practice or just need some quick advice.”

Emergency department staff specialist Dr Deanne Crosbie said the emergency department was at its busiest after hours.

“Evenings, nights and weekends are peak times for the ED,” she said.

“It’s so important for people to know their options in the community and understand what is open late on weekdays and on weekends.

“We will always see patients at the ED, but I’d rather sit and wait at a GP than wait four hours in the ED if all I need is a script or a wound dressed.”

Dr Crosbie said many people in the community waited too long before seeking medical care resulting in unplanned ED presentations.

“We know people who are unwell with chronic illnesses hold off because they don’t want to come up to the hospital and inevitably wait, she said.

“As their condition worsens, they end up presenting quite late in the day.”

Dr Crosbie said if a patient’s condition did get to a point where they needed to present to the ED, having a good history with a GP was still important.

“If a 35-year-old-woman suddenly gets pelvic pain and she’s got a documented history with a GP we can ask what her GP was thinking, what investigations have been worked through and what diagnosis they were working on,” she said.

“It allows us in the ED to know what has been ruled out, what has been considered and know which direction to take a person’s care.

“This allows for continuity of care which is so important in healthcare. People who have continuity of care with a single GP don’t have to come to the ED very often.”

Dr Crosbie said the continuity of care worked both ways, with emergency department physicians often diverting care back to GPs.

“I will ask patients if they have a GP they trust,” she said.

“If they do, I can ask if their GP is happy to support follow-up care when they are discharged from ED and do things like wound dressings.

“That is why we value the local GP community; they are so pivotal to helping manage patients who require additional steps to manage their condition when they leave ED.

“I always tell junior doctors to write a really good letter to a patient’s GP when they are discharged.

“It helps them to know what we were thinking, what treatment we provided and what happens next for the patient.”

Dr Weller said it was important for emergency department doctors to have somewhere to handover care.

“You definitely need somewhere ED can hand the care over to because we work as a team,” she said.

“The relationship with ED is a two-way street and there are times I will send a patient there.

“It might be a patient that needs more workup and investigation because they are unwell from an uncertain cause and I feel something needs to be done in a timely manner,” she said.

“It might take three or four days in the community to investigate so I make a judgement that the ED can assist in providing timely care to someone before they deteriorate.

“I always ask myself the question of what value a trip to the ED will add because at the end of the day, asking people to do things such as get someone else to pick up their kids so they can go to ED is a stress on them.

“My goal always is to have questions answered so I can continue their care.”

Dr Weller said she encouraged people to be empowered in their healthcare.

“If you know where and when to seek help you feel more in control,” she said.

“GPs and the ED are always there to support you.

“Usually people who plan and anticipate get better health outcomes because they feel empowered.”

Dr Weller’s message to the community was to plan what you can when it came to healthcare.

“There are a lot of health services and that can be complex and overwhelming, but your GP can help you navigate them,” she said.

“The emergency department can be part of your care but may not be the first place to go.

“You might get the best care by having everybody involved.

“We are all in this together and as doctors, we simply want good health outcomes for the people in our community.”