Fracture clinic redesign: improving standards in patient care and interprofessional education

Murray, Odhrán; Christen, Kate; Marsh, A.G.; Bayer, J

doi:10.4414/smw.2012.13630

Cited by 14 publications

(32 citation statements)

References 23 publications

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“…For patients reviewed in the VFC, this is further emphasised by telephone communication with the patient and review arranged—at the most appropriate clinic—where necessary. Such processes have benefits for patients by reducing unnecessary attendance and interventions such as repeat radiographs,16–18 along with improved orthopaedic training experiences 19…”

Section: Discussionmentioning

confidence: 99%

Effect of a redesigned fracture management pathway and ‘virtual’ fracture clinic on ED performance

et al. 2014

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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.

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Section: Discussionmentioning

confidence: 99%

Effect of a redesigned fracture management pathway and ‘virtual’ fracture clinic on ED performance

et al. 2014

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“…However, some fracture clinics have high return and low discharge rates, suggesting unnecessary attendance and a need for 'redesign’ [5]. For children in particular, there is considerable associated socio-economic cost for fracture clinic attendance [6].…”

Section: Resultsmentioning

confidence: 99%

“…A rapid review clinic of radiographs and case notes has been used elsewhere [5,11] to increase Consultant involvement/input and subsequent fracture clinic efficiency, minimising delays in later clinical decision-making. Information technology advances have certainly made such systems increasingly practicable.…”

Section: Discussionmentioning

confidence: 99%

Paediatric fracture clinic design – current practice and implications for change

Huntley

2014

BMC Res Notes

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BackgroundIn our region there has been considerable success in the redesign of adult fracture clinics. The aim of this study was to define our paediatric fracture clinic load, to assess the feasibility of increasing efficiency by decreasing inappropriate attendance.FindingsProspective case notes review of all attendees at 6 serial fracture clinics at the Royal Hospital for Sick Children (Glasgow) which has both local and tertiary referrals. Of 234 consecutive attendances across 6 fracture clinics, 34 (15%) were judged inappropriate: 13 had fractures not requiring orthopaedic follow-up (radial torus/clavicle/undisplaced metacarpal), and 21 had diagnoses or situations that were not appropriate. Of the 200 attendances deemed appropriate (172 fractures, 11 soft-tissue injuries, 9 infections and 8 acute atraumatic limps), there were 33 new referrals from the emergency department, and a further 39 were first-time attenders at the fracture clinic after an acute admission (37 were post-operative and 2 were non-operative). Of these 200, the treatment plan was changed for 67 (34%), a cast removed or exchanged for 92 (46%), and radiographs taken for 153 (77%). The overall discharge to return ratio was 76:158 (1:2.1), and for appropriate attenders 61:139 (1:2.3).ConclusionsTighter discipline can be applied to indications for fracture clinic appointments, including certain fracture types being discharged from the emergency department without unnecessary review - our particular fracture clinic numbers can be decreased by 15%. In the remaining attendances there are high radiograph and intervention rates, such that it seems unlikely that further reductions in attendance would be feasible.

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“…The under-developed conceptualisation of clinician experience was reflected in the lack of survey research in this field. Twenty studies (18 from the database search and two from the grey literature) included survey methods to capture clinician experience data, with no single survey instrument widely adopted within these studies (27,28,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56). Of the identified studies, only two survey studies sought to assess clinician experience of providing care beyond a specific change event and using a survey instrument explicitly capturing experience outcomes (41,56).…”

Section: Question 2: What Survey Instruments and Measures Of Cliniciamentioning

confidence: 99%

“…In a group of nine studies, authors developed their own surveys in the absence of existing validated measures to capture experiential data from clinicians about current processes of care provision or specific changes to care provision, including the introduction of an electronic health record (EHR), the treatment of sepsis, and redesign of observational charts(43) (44, 45) (52) (23,50,51,53,55). In these studies, surveys were often lengthy, with multiple components.…”

Section: Question 2: What Survey Instruments and Measures Of Cliniciamentioning

confidence: 99%

Clinicians’ Experience of Providing Care: A Rapid Review

Iqbal¹,

Manias

Mimmo

et al. 2020

Preprint

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Background Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation. Methods: A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. 79 studies retrieved from the literature were included in the review. 14 articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health. Results: Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician’s experience has been identified to have a paucity of measurement tools. Conclusion: Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader ‘clinician pulse’ style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

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Fracture clinic redesign: improving standards in patient care and interprofessional education

Cited by 14 publications

References 23 publications

Effect of a redesigned fracture management pathway and ‘virtual’ fracture clinic on ED performance

Effect of a redesigned fracture management pathway and ‘virtual’ fracture clinic on ED performance

Paediatric fracture clinic design – current practice and implications for change

Clinicians’ Experience of Providing Care: A Rapid Review

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