Aims Fracture clinics are often characterised by the referral of large numbers of unselected patients with minor injuries not requiring investigation or intervention, long waiting times and recurrent unnecessary reviews. Our experience had been of an unsustainable system and we implemented a ‘Trauma Triage Clinic’ (TTC) in order to rationalise and regulate access to our fracture service. The British Orthopaedic Association’s guidelines have required a prospective evaluation of this change of practice, and we report our experience and results.
Patients and Methods We review the management of all 12 069 patients referred to our service in the calendar year 2014, with a minimum of one year follow-up during the calendar year 2015.
Results Following the successful introduction of the TTC, only 2836 patients (23.5%) who would previously have been reviewed in the general fracture clinic were brought back to such a clinic to be seen by a surgeon. An additional 2366 patients (19.6%) were brought back to a sub-specialist injury-specific clinic. Another 2776 patients (23%) with relatively predictable injuries were reviewed by a nurse practitioner according to an established protocol or specific consultant instructions. A further 3222 patients (26.7%) were discharged from the service without attending the clinic. No significant errors or omissions occurred with the introduction of the TTC.
Conclusion We have found that our TTC allows large numbers of referrals to be reviewed and triaged safely and effectively, to the benefit and satisfaction of patients, consultants, trainees, staff and the organisation. This paper provides the first large-scale review of the instigation of a TTC, and its effect, acceptability and safety.
Cite this article: Bone Joint J 2017;99-B:503–7.
T. O. White: Study design, Data analysis, Writing the paper, Paper submission and revision.
S. P. Mackenzie: Study design, Data collection, Writing the paper, Paper submission and revision.
T. H. Carter: Data collection, Writing the paper, Paper submission and revision.
J. G. Jefferies: Data collection, Writing the paper, Paper submission and revision.
O. R. Prescott: Data collection, Writing the paper, Paper submission and revision.
A. D. Duckworth: Study design, Writing the paper, Paper submission and revision.
J. F. Keating: Study design, Writing the paper, Paper submission and revision.
The authors would like to acknowledge and thank their trauma consultant colleagues for their hard work in delivering the TTC, especially C. M. Robinson and C. W. Oliver for their substantial contributions.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by P. Page and first proof edited by J. Scott.
- Received August 29, 2016.
- Accepted November 7, 2016.
- ©2017 The British Editorial Society of Bone & Joint Surgery