This website is aimed at health professionals interested in the process of service redesign. If you are injured and seeking advice, you should contact a relevant health professional.
Traditionally, all patients who sustain a broken bone (fracture), are given an appointment for a fracture clinic. This often happens on the day following the injuries. These clinic are often busy and can be quite bewildering. There is often removal and application of plaster casts, along with taking x-rays. The patient is also usually reviewed by a member of the orthopaedic team to check progress. A patient may have to attend the clinic multiple times during the resolution of their injury.
The reasons for the development of this system are complex and reflect the historical treatment of many fractures. Some fractures are displaced and need to be put back in the correct position. Other fractures, although in a good position initially, can move, and need to be monitored. Most of these “unstable” fractures are now managed with operations to stabilise them at an early stage. The reliance on plaster casts to hold bones in alignment is less important (in adults) and removable splints can be used in many cases to reduce discomfort in the early stages after an injury. Other injuries are not immediately apparent and need to be reviewed after a period to time to determine if there is actually a broken bone.
Coming to a clinic in the first few days after an injury is uneccessary in many cases, as no change is required to treatment. If a removable splint is used, there is no need for changes of plaster cast. In many cases, it can be apparent at the first fracture clinic visit, that the early opinion of a specialist is required, and this means a further appointment. Visits in the first few days are often the most difficult as pain and immobility are greatest.
The Orthopaedic Department at Glasgow Royal Infirmary recognised many of these problems and redesigned the way it manages broken bones and injuries that do not require surgery. The goal was to ensure that all patients are managed in a safe and effective manner, at the correct time and by the correctly trained person. The extensive skills of the Emergency Department staff are used to provide treatment and information to the most simple injuries without referral to the orthopaedic department. All other injuries are reviewed within 48 hours by an orthopaedic consultant. The x-ray is reviewed (this can be done on computer now) and the emergency department file is read. A specially trained, experienced, nurse contacts patients by telephone after this meeting and discusses treatment. This might consist of purely advice and discussion, but may require the arranging of an appointment at the most appropriate clinic. All of this is backed up by a dedicated advice line and information leaflets.
The unit has assessed this process and has reported high rates of satisfaction.