INFOGRAPHIC
Infographic: Trauma Triage Clinic reduces unnecessary fracture clinic attendances and costs with comparable clinical outcomes S. P. Mackenzie, T. H. Carter, J. G. Jefferies, J. B. J. Wilby, P. Hall, A. D. Duckworth, J. F. Keating, T. O. White From Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom S. P. Mackenzie, MBChB, BSc (Hons), MRCS(Ed), Specialty Registrar T. H. Carter, BSc(Hons), MBChB, MRCS(Ed), Specialty Registrar J. B. J. Wilby, BSC(Hons), Medical Student A. D. Duckworth, BSc(Hons), MBChB, MSc, FRCSEd(Tr&Orth), PhD, Consultant Orthopaedic Trauma Surgeon J. F. Keating, FRCSEd(Tr&Orth), Consultant Orthopaedic Trauma Surgeon T. O. White, FRCSEd(Tr&Orth), MD, FFTEd, Consultant Orthopaedic Trauma Surgeon Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK. J. G. Jefferies, MBChB, Specialty Registrar Department of Trauma and Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK. P. Hall, MB ChB, MRCP, PhD, Professor of Oncology Cancer Research UK Edinburgh Centre, MRC Institute of Genetics & Molecular Medicine, The University of Edinburgh, Western General Hospital, Edinburgh, UK. Correspondence should be sent to T. O. White; email:
[email protected] ©2018 The British Editorial Society of Bone & Joint Surgery doi:10.1302/0301-620X.100B7. BJJ-2018-0623 $2.00 Bone Joint J 2018;100-B:957–8.
VOL. 100-B, No. 7, JULY 2018
Trauma triage clinics (TTC) are designed to rationalise and regulate outpatient fracture man-
agement through the consultant-led triage of referrals.1,2 We have previously shown that orthopaedic 957
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S. P. MACKENZIE, T. H. CARTER, J. G. JEFFERIES, J. B. J. WILBY, P. HALL, A. D. DUCKWORTH, J. F. KEATING, T. O. WHITE
surgical consultations can be safely reduced by more than 50% by adopting such a system.1 A key component of the TTC system is the direct discharge of minor fractures from the Emergency Department, reducing the burden of unnecessary appointments to both patients and medical services.3 The United Kingdom National Institute for Clinical Excellence (NICE) and British Orthopaedic Association Standards for Trauma (BOAST) have recommend further research into the clinical outcomes and cost-effectiveness of these systems. In this study, patient reported outcomes measures (PROMS), and complications following fractures managed immediately before and after the implementation of the Edinburgh TTC, were reported.4 PROMS were as good or better post-TTC, compared with preTTC scores, without an increase in complications, and overall patient satisfaction was higher. Significantly fewer appoint-
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ments and radiographs were required post-TTC, with a fourfold reduction in mean total costs per patient. In summary, TTC reduces unnecessary attendances and costs and has high rates of patient satisfaction, without compromising clinical outcomes.
References 1. White TO, Mackenzie SP, Carter TH, et al. The evolution of fracture clinic design: the activity and safety of the Edinburgh Trauma Triage Clinic, with one-year follow up. Bone Joint J 2017;99-B:503–507. 2. Jenkins PJ, Morton A, Anderson G, Van Der Meer RB, Rymaszewski LA. Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care. Bone Joint Res 2016;5:33–36. 3. McKirdy A, Imbuldeniya AM. The clinical and cost effectiveness of a virtual fracture clinic service: An interrupted time series analysis and before-and-after comparison. Bone Joint Res 2017;6:259–269. 4. MacKenzie SP, Carter TH, Jefferies JG, et al. Discharged but not dissatisfied: outcomes and satisfaction of patients discharged from the Edinburgh Trauma Triage Clinic. Bone Joint J 2018;100-B:959–965.
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