An investigation to watch: how to better integrate primary care and public health

I work as a nurse in the emergency department of a public hospital. In my opinion the majority of patients present to ED with issues they could, and should have been dealt with in the community. These include people with chronic conditions like lung and cardiac disease, diabetes, cancer and end stage diseases like dementia. However they end up in ED because unskilled staff in nursing homes and deskilled GP’s ‘don’t know what to do’ so they call an ambulance. I can see no coordination of patient information between medical specialists, GP’s and aged care. I am not aware of any care plans, follow ups and case management strategies in the community. As a result, patients have to wait for hours in uncomfortable trolleys, to receive short term ‘fixes’ for what is mostly an exacerbation of a chronic disease, and then be quickly discharged (so the hospital does not go over it’s waiting times and be fined). The result is that they often re-present months, weeks or even hours later, with the same condition. In my opinion, in order to improve the health system, we need to radically restructure it. I believe all health professionals should have to undergo stringent tests and regular education as a mandatory part of the yearly re-registration process. Patient education should be comprehensive, and include clear information about many diseases being ‘chronic’ not ‘curable’. Nursing homes and hostels need 24/7 access to GP’s, and properly trained RN’s always available on site to manage patient care. The entire community needs better palliative care services. I would like to see all patients with chronic illnesses to be case managed, with links to pharmacy, GP’s, specialists and community nurses. Patients left in ED on a trolley with no food, drink and wanting to go to the toilet are not receiving the care they should. Nurses and doctors running around trying to ‘insert IV’,s do ECG’s, take bloods and do admission paperwork’ of patients who regularly present with similar conditions are not being productive with their time or skills. http://www.cancerquestions.com.au