Abstract
Background Fracture clinic (FC) and Paediatric Emergency Department (PED) have a crucial relationship in the management of musculoskeletal (MSK) injures in children. A high volume of patients are assessed in FC and even a small number of inappropriate and non-specific referrals severely disrupts the flow of FCs.
Chelsea and Westminster Hospital, London, has seen a rapid increase in children attending PED and subsequent referrals to FC. In light of this, we set up a MSK clinic.
Objectives To reduce the number of inappropriate referrals made from the PED to FC.
Methods PED referrals to FC prior to the introduction of the MSK clinic were audited. Data was collected retrospectively from 22 consecutive FCs over a 10-week period from February 2019 to April 2019. Patient demographics, diagnosis and management were recorded for these patients. PED referrals to FC were re-audited after the MSK clinic was set up. 18 consecutive FCs were retrospectively analysed over a 9-week period from January 2020 to March 2020. The appropriateness of these referrals was compared before and after the establishment of the MSK clinic.
An appropriate referral was defined as one in which the resulting diagnosis was a fracture, and a referral was classed inappropriate if the diagnosis was not.
Results The initial audit in 2019 which included 203 children referred to FC by PED showed that 35.5% of referrals were inappropriate. After the introduction of the MSK clinic, the re-audit demonstrated an improvement, as of the 178 referrals, only 26% were non-fractures.
Most notably, the number of ‘unspecified injury’ referrals decreased in 2020 compared to 2019 (29% in 2019 to 9% in 2020).
Conclusions The introduction of the MSK clinic has proven an effective way of reducing the number of inappropriate and non-specific referrals made by PED to FC.
