ObjectivesCollaboration between the orthopaedic and emergency medicine (ED) services has resulted in standardised treatment pathways, leaflet supported discharge and a virtual fracture clinic review. Patients with minor, stable fractures are discharged with no further follow-up arranged. We aimed to examine the time taken to assess and treat these patients in the ED along with the rate of unplanned reattendance.DesignA retrospective study was undertaken that covered 1 year before the change and 1 year after. Prospectively collected administrative data from the electronic patient record system were analysed and compared before and after the change.SettingAn ED and orthopaedic unit, serving a population of 300 000, in a publicly funded health system.Participants2840 patients treated with referral to a traditional fracture clinic and 3374 patients managed according to the newly redesigned protocol.Outcome measuresTime for assessment and treatment of patients with orthopaedic injuries not requiring immediate operative management, and 7-day unplanned reattendance.ResultsWhere plaster backslabs were replaced with removable splints, the consultation time was reduced. There was no change in treatment time for other injuries treated by the new discharge protocol. There was no increase in unplanned ED attendance, related to the injury, within 7 days (p=0.149). There was a decrease in patients reattending the ED due to a missed fracture clinic appointment.ConclusionsThis process did not require any new time resources from the ED staff. This process brought significant benefits to the ED as treatment pathways were agreed. The pathway reduced unnecessary reattendance of patients at face-to-face fracture clinics for a review of stable, self-limiting injuries.

Objectives & Background The Redesigned Fracture Pathway has revolutionised fracture management, decreased orthopaedic workload and improved the patient journey. The Pathway consists of guideline driven treatment of patients with fractures. There is no follow up for many stable injuries, virtual review of other fractures and orthopaedic registrar referral for admission decisions. Many discharged patients never receive a clinic appointment necessitating the development of discharge information leaflets and a move from plaster casts to Velcro splints. Have orthopaedics simply passed their workload onto the Emergency Department? 1) Patients with fractures are discharged with no follow up, does this necessitate longer consultations in ED? 2) Without routine follow up do patients simply pitch back up to ED? 3) Has the admissions process actually improved? Methods We examined length of consultations, unplanned reattendances to ED within 7 days, number of Orthopaedic admissions and time from first assessment to admission before and after Fracture Clinic Redesign. Results 1) Length of consultation was unchanged for discharges without follow up, (p=0.316, 0.508, 0.571). Consultations were shorter when splints replaced casts, (p=0.046, 0.588, 0.032). 2) Unplanned reattendances within 7 days did not increase as a proportion of ED attendances, (p=0.779). 3) Orthopaedic admissions fell by 7.9% and time from first assessment to admission by 9.6% per annum (p=0.002, p=0.011). Orthopaedic breaches decreased significantly, (p<0.001). Conclusion Direct discharges from ED do not require longer consultations nor do they return to ED. Orthopaedic admission is increasingly efficient and breaches are down. Is Fracture Pathway Redesign good for the Emergency Department? Yes!

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