"My child's broken bone being missed"

I am writing to provide some feedback on our experience recently at Perth Children’s Hospital. I preface this story with a deep appreciation that staff are pressured and hospital resources are very limited, and that in our experience, the staff were friendly and very caring. However, I do hope that this feedback may prompt some thinking around how non-life threatening cases are handled, so that the right decisions are made in the first instance. Which as with our case, I believe may prevent days of undiagnosed breaks and the provision of the right treatment when it is most needed. 

After falling from a very high slide onto their shoulder and neck on the weekend in the afternoon, we brought my toddler child to PCH. Given the height of the slide and their extreme pain after the fall, we wanted to get my child fully checked and were prepared for a longer wait. Once through, the staff examined my child's movement in the affected area and vitals. We actually caught a good portion of the fall and height of the slide on video which proved strangely helpful. Whilst my child could bend their fingers and elbow, the shoulder area was clearly very painful and they could not lift that arm.

The staff advised it was very busy and they didn’t think it worthwhile waiting for x-rays, so with some Panadol and Neurofen administered we were released and told it was just likely jarred. I did ask a couple of times if they were sure about no x-rays, as my child was definitely not themself and in pain, so this decision took me by surprise. I believe it was clear they were exceptionally busy and seemingly under a lot of pressure with other patients, so I did not push the issue further.

My child was in a lot of pain that night, and agony the next day, I even had to cut their clothes off them to get them in the shower. Not wanting to be turned away from PCH with no x-ray again, I went to our GP later in the day Monday and my child was x-rayed at a radiology clinic more recently, almost two days after the ED visit. There is a, mid-clavicle fracture with full thickness superior displacement of the medial fragment with overlap, or to my untrained eyes a significant collar bone break on the x-ray which of course explained all of their pain.

So back to PCH that day almost 48 hours after the incident to get the appropriate examination, sling fitted and advice on treatment/recovery. We of course feel terribly frustrated that for 2 days we have been trying to carry on thinking it was just jarred, whilst my child was clearly in pain and had no sling for support. In particular that all of this could have been so easily avoided with the extra check of an x-ray.

As a parent sitting in a busy ED full of urgent cases, I understand that prioritisation needs to happen and that this case was not urgent, which was what made me reluctant to challenge the decision made on not x-raying. However, I do feel strongly that had a different decision been made on that night it would have saved PCH the extra resources later on, and a lot of pain for our family and my child since they left that night.

I am sure I am not the only parent who has sat there reluctant to speak up because they felt their case was not as urgent as those surrounding them, but knew deep down there was something more that needed to be done/investigated. Is there a better way that these types non-life threatening cases could be managed, so that they are still treated with the requisite rigour, albeit likely longer wait times?