Consultant-led triaging service for fracture clinic: An innovative way of improving patient safety and clinical care?

Abstract

Abstracts / Injury Extra 42 (2011) 95-169 163 the primary THR was anterolateral (15 cases), posterior (53) and tran-trochanteric (6). Mechanism of dislocation included traumatic (25) and non-traumatic causes (49) cases. Dislocations after primary THR were 9 within the first month of surgery, 26 between 1 and 12 month, 24 after the first year. After revision THR there were 8 dislocations between 1 and 12 months. Revision procedures were performed on 31 patients. After the first dislocation, the risk of a further dislocation was 28.4%. Risk factors for dislocations included rheumatoid arthritis (8 cases), dementia (3), extensive hip muscle/tissue damage (2), trochanteric non-union (8). The mean acetabular inclination was 44 • (27-72). The mean number of days of hospitalisation was 8.37 days. The cost of hospitalisation excluding cost of medical or surgical intervention was £900,000 GBP.Conclusion: The incidence of THR dislocation was 2.4%. The risk of subsequent dislocation after the first one was 28.4%. The requirement for revision THR was 42%.Aim: To evaluate whether the use of a consultant-led triaging service for acute referrals to fracture clinic improves the management of patients who require urgent early intervention.Methods: An audit of prospectively collected data from the Patient Administrative System (PAS) was carried over the period of 1 month, which assessed the waiting time to fracture clinic appointments and the subsequent late admission rate. We defined the late admission rate as the proportion of patients admitted after their first fracture clinic appointment who had a delay of ≥5 days from their initial referral.A consultant-led triaging service was subsequently implemented. X-rays (on PACS) and A&E notes of patients were assessed and the referrals assigned to one of three categories: 1. Admit/or Call Back Patient for Urgent Review. 2. Discharge Patient. 3. Keep Current Appointment. The subsequent waiting time for fracture clinic and late admission rate were re-audited.Results: A total of 367 new A&E referrals were seen in fracture clinic during the audit period. The median waiting time to be seen in fracture clinic was 10 days (range of 1-29 days). 14 patients (3.8%) were admitted for further management from their first fracture clinic appointment after having waited ≥5 days from their initial referral. On re-audit, the median fracture clinic wait time was 9 days (range of 0-28 days). The late admission rate from clinic fell to 0.9%.Conclusion: Fracture healing occurs within a limited time frame, therefore a delayed clinic appointment for an injury that requires urgent intervention not only has an impact on clinical care but can lead to serious medico-legal consequences. We have shown that the use of a simple consultant-led triaging service reduces the late admission rate from fracture clinic and subsequently improves the clinical management of our patients.