1004 Assessing Appropriateness of Referrals to the Trauma and Orthopaedic Department

Abstract

Abstract Background The Trauma and Orthopaedic (T&O) on-call service receives referrals from the emergency department (ED), general practice (GP), urgent treatment centres (UTCs), and requests for inpatient reviews. The virtual fracture clinic (VFC) pathway allows ED and UTC clinicians to assess, discharge and refer when necessary. For VFC, the on-call Orthopaedic Consultant will review the case the next working day and make an appropriate plan. The VFC pathway consists of a traffic light system, in which clinicians can safely discharge with written advice (green), refer to the VFC (yellow) or refer to the on-call team (red). Method The aim was to assess how the VFC pathway was being utilised. All referrals to the T&O on-call team over 3 weeks were assessed retrospectively. The following referrals were excluded - Fractured Femur, Head Injury, Trauma Calls and Back Pain Pathway. The following data was collected - Patient details, diagnosis, referral source, the reason for referral, plan, double booking with VFC and appropriateness. Results 191 referrals were analysed. Most referrals are from the ED (51%) and UTC (23%). 35% of referrals were deemed to be inappropriate. 38% of inappropriate referrals (25/66) should have been referred to VFC. A significant minority (7%) were referred to the on-call team and VFC. Conclusions Education and collaboration are required with ED and UTC to ensure the proper use of the VFC pathway. The recent integration of documentation systems will assist in ensuring all clinicians have access to relevant information. Documentation of trauma meeting outcomes should be standardised.