Do all adult orthopaedic injuries seen in emergency departments need to attend fracture clinic? A Queensland multicentred review

Abstract

Adopting the PCP could potentially reduce fracture clinic referrals by 40%. Having a structured pathway has the potential to empower primary health professionals, which could result in a more streamlined process that aids in significant time and financial savings and maintains good patient satisfaction and outcomes.

Validation of the Primary Care Pathway Model for Management of Orthopedic Injuries: Results of a Prospective, Queensland Study

“…This is consistent with the findings by previous VFC literature, which demonstrated that 40% of patients referred to FC were suitable for a PCP model of care over an 8-week study period. 10 This reduced the workload of orthopedic FCs, which allowed more time for complex patient presentations and gives primary care providers a more direct involvement into the management of their patient's acute injury.…”

“…Not all diagnoses deemed suitable for the PCP outlined by existing Queensland VFC model were included, with this study instead limited to the highest volume injuries. 10 Patients were referred back to FC if there was inadequate information in the referral to make an accurate assessment, the diagnosed injury was incorrect, the X-rays were inaccessible, the patient had a cast in-situ or the diagnosed injury was not part of the PCP protocol (Figure 1). ED staff were educated about the inclusion criteria of the PCP pathway prior to the implementation of the protocol, and patients who met inclusion criteria were educated on the follow-up protocol and given a fact sheet with relevant information regarding their provisional diagnosis.…”

“…The total FTA during the study period was 11%, which is similar to the findings in the preliminary PCP study, which demonstrated an 11% FTA rate of all attendance. 10 Interestingly, 100% of the referred patients who eventually failed to attend were referred to FCs, while those referred to PCP did not miss a follow-up. This most likely represents a transfer bias as patients may have more motivation to attend their appointment based on their knowledge of participation in a recently implemented system.…”

“…9 A 2017 review of the number of presentations to FC at Logan and Redlands Hospitals (Queensland Health Metro South Health Service) over an 8-week period revealed that 40% of referrals made to FC would have met criteria for allocation and been suitable for redirection into the Queensland based Primary Care Pathway (PCP) model of care. 10 The PCP model implements a similar method to the VFC model seen successfully used by the GRI and the NHS, thus representing a type of VFC.…”

Profile and Motivation of Patients Consulting in Emergency Departments While not Requiring Such a Level of Care

“…Their conclusions remain prudent and more studies of these organizations, which seem to attract patients and could help to resolve ED overcrowding, are necessary [9]. This type of management could reduce the number of consultations in EDs by 40% and yield significant improvements of time and resources [40].…”