The goals of the fracture clinic redesign process were to ensure that:
- Simple, stable injuries that do not require specialist review are managed once, definitively by the Emergency Department
- Injuries that required specialist review were assessed rapidly by a consultant, with a decision made about review and treatment
- Any face-to-face review was at the appropriate time, by the correct team: there should be no wasted encounters
- Diagnostic uncertainty should be resolved early through use of clinical protocols and imaging
- Adequate time is available for both telephone and face-to-face consultations
- Follow-up appointments should be at standard intervals agreed by the specialty teams, for predefined goals
- Variation in management should be eliminated
- Training and support of junior medical staff is enhanced
We aimed to develop a high-quality process to achieve these goals. The process is modelled on the Institute of Medicine’s aims for high-quality healthcare:
- Safe
- Patient-centred
- Effective
- Timely
- Efficient
- Equitable