PP3 The knee injury clinic: trying to get it ‘right first time’ for emergency department soft tissue knee injuries

Abstract

Open access specialist knee clinics are a proven method to dramatically reduce the delay to diagnosis of soft tissue knee injuries (STKI). This service was introduced at the Royal Berkshire Hospital in 2011 taking referral from primary care and the emergency department (ED). The purpose of this audit was to (i) identify the incidence and diagnoses of STKIs in patients referred from the ED; (ii) evaluate the management of patients’ referred from the ED to the acute knee injury clinic (AKIC) and implement changes to improve this service. An initial retrospective analysis of 150 consecutive ED referrals to the AKIC in 2011/12 was undertaken. Paediatric patients were excluded as streamed to a separate clinic. Time to first clinic appointment (FCA), diagnosis and surgical intervention was recorded. Following initial findings, recommendations were implemented to increase ED staff education, a new patient leaflet was introduced and clinic frequency was increased to twice weekly. In 2012/13 the audit loop was closed and a further 150 consecutive ED referrals were reviewed. 222 of the 300 patients referred were seen in the AKIC, 51 patients did not attend and 27 were streamed to paediatric clinic. Anterior cruciate ligament rupture (ACL) was the most frequent injury referred to the AKIC (24% (54/222)), 78% were sustained through sporting activity. Mean time from ACL injury to ED presentation was three days. Audit interventions led to a reduction in mean time from ED referral to FCA by 67%. Patient AKIC non-attendance rate decreased by 49% and mean time from FCA to surgical intervention was reduced from 97 to 75 days. 83 patients underwent surgery. Simple interventions led to a reduction in time to diagnosis with suitable counselling and management, reducing socio-economic cost of knee injuries and helping to prevent secondary injuries. ACL rupture is common and presents early. Identifying the type and frequency of STKIs presenting to AKIC will help to plan future services.