This is what I do in my public ED

This is a common response from some FACEMs regarding patient complaints about our services. One common scenario is the following:
- The patient attended the ED for a sprained finger or ankle.
- No fracture on initial X ray.
- The patient is discharged with an outpatient ultrasound request form and referral to GP for follow-up, in addition to analgesia +/- splint etc.
- The patient has to book the US which is done two weeks later
- The patient goes to see GP regarding the US which found a ruptured tendon. The patient is then referred to an orthopaedic surgeon
- The patient finally sees the surgeon in 2 weeks.
- If any repair is needed, there could be another few days delay.
Up to this point, the patient has spent nearly $1,000 and 4-5 weeks before they get management of their injury. Obviously, the patient is not happy as the patient can have the same for free via the public ED. The patient paid for a gold pass ticket a movie in Hoyts but the patient received no drinks and finger food at the end.

We offer our service for a fee - where is the difference of your service in our ED from the free service via a public ED?

The following management to be considered:
- Organise an outpatient US with radiology department before the patient is discharged
- Refer the patient to an orthopaedic surgeon to follow-up the US. The patient can always cancel the referral if the US is normal and pain is getting better or ask the patient to represent to ED for follow-up (scheduled ED review is not charged but the FACEM but can bill Medicare).
The patient may spend a similar amount of money in terms of US cost and orthopaedic consult, but it takes much less time - this is perceived by the patient as a better service than the free service from a public ED.

The attitude of “This is what I do in my public ED” does not make a cut in our private ED - the patients are paying for a better service than you could offer in a public ED.