The Emergency Department (ED) (along with Minor Injuries Units – MIUs) is a crucial component of a redesigned fracture clinic process. The ED is where most pathways commence. We have recently published the effects of this protocol on the ED.
The main components of the redesigned pathway in the ED are:
- ED Direct Discharge: Many simple stable fractures and injuries can be discharged with standardised advice, access to telephone advice and no further follow-up
- Virtual Clinic Referral: All other non-operative fractures are referred for discussion at the virtual clinic
- Fast-track Admission: The majority of common fractures that need surgery can either be directly admitted without further review in the ED, or arrangements made for return for semi-urgent surgery.
There are several benefits to the ED of Fracture Clinic Redesign:
- Simplified Referral Pathway
- Standardised leaflets for explanation and advice
- Dedicated telephone advice line
- Reduction in time taken to manage patients
The ED staff are already highly skilled in the definitive management of many minor injuries. For historical reasons, fractures have usually resulted in a subsequent fracture clinic review. The redesign process recognises the skills already present and empowers the staff to deliver definitive management of several simple, stable injuries. It also provides a standardised environment where all other injuries not requiring admission will be reviewed by a consultant on an urgent basis. The telephone helpline provides back-up to patients where recovery is less than predicted and counselled.
The crucial Redesign Elements in the ED are:
- Identification of stable, simple injuries that do not require follow-up & creation of evidence based protocols
- Well designed information, evidence based, leaflets with expected time-frame for recovery
- Standardised protocols for referral to the Virtual Clinic
- Standardised protocols for management of diagnostic uncertainty (clinical scaphoid fracture)
- Use of removable velcro splints (wrist splint & moon-boots) to remove need for backslab and plaster changes
- Helpline to contact for any queries or concerns
- Adequate reporting of radiographs and verification of report
Please also see our FAQ section which contains answers to common questions.