COVID-19 – Changes in the presentation and management of shoulder and elbow trauma in a UK district general hospital orthopaedic department

Introduction COVID-19 has had a significant impact on healthcare systems. We aim to quantify the impact of this outbreak on shoulder and elbow trauma in our institution. Methods We prospectively collected data on patients presenting to our hospital with shoulder and elbow injuries during COVID-19. This included the number of attendances to the emergency department, fracture clinic, inpatient admissions and operative treatments. This was compared to a pre-COVID-19 period. We also assessed the efficacy of telephone clinics. Results There has been a noticeable decrease in the number of emergency department and fracture clinic attendances with upper limb complaints. The number of in-person fracture clinic reviews also decreased, with a reciprocal exponential increase in telephone consultations. We recorded a decrease in the number of shoulder and elbow trauma procedures performed. There was a small increase in the proportion of injuries treated conservatively during COVID-19. Our telephone clinics yielded a diagnosis and management plan in many cases and patient perspective appeared favourable. Conclusion We have noted significant change in the upper limb caseload. Certain injuries have reduced, likely due to COVID-19 lockdown. Moreover, we consider several changes to current practices could be taken forward after the pandemic.

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Outcomes measurement for asthma following acute presentation to an emergency department

Australian Health Review ◽

10.1071/ah010053 ◽

2001 ◽

Vol 24 (3) ◽

pp. 53 ◽

Cited By ~ 5

Author(s):

Geoff Masters ◽

Sonj E Hall ◽

Martin Phillips ◽

Duncan Boldy

Keyword(s):

Emergency Department ◽

New Zealand ◽

Clinical Pathways ◽

Asthma Management ◽

Management Plan ◽

Asthma Care ◽

Outcomes Measurement ◽

Acute Presentation ◽

Asthma Outcomes ◽

The Impact

The Asthma Management Plan (AMP) was developed by the Thoracic Society of Australia and New Zealand in 1989to provide a more uniform approach to asthma care, aimed at reducing mortality, morbidity and emergencypresentations. The AMP is often supplemented with Asthma Clinical Pathways (CPs) within the emergencydepartment and hospital setting.This study was designed to evaluate the impact of these two instruments on asthma outcomes one month afterpresentation to the emergency department. The AMP and CP were both found to have had positive influences onasthma management. However, the study illustrates that there continue to be problems with asthma management,which would be improved by a more consistent use of these instruments.

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194 Referral of Paediatric Fractures from The Emergency Department to Virtual Fracture Clinic

British Journal of Surgery ◽

10.1093/bjs/znab259.016 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

D Effiom

Keyword(s):

Emergency Department ◽

Cost Effective ◽

District General Hospital ◽

National Guidelines ◽

Fracture Clinic ◽

The United Kingdom ◽

Retrospective Audit ◽

National Guidance ◽

Fracture Diagnosis ◽

Virtual Fracture Clinic

Abstract Introduction Virtual Fracture clinics (VFCs) are an alternative to the traditional fracture clinic. Recent evidence reports them to be safe, cost-effective, and efficient model without significant compromise to patient care. Aim This audit aims to assess VFC referrals from the paediatric emergency department (ED) and ensure the appropriateness of these referrals. Method This was a retrospective audit done at a large district general hospital in the United Kingdom (UK). We included patients under 18 years old presented to the emergency department with suspected or confirmed fractures and referred to virtual fracture clinics within a period of one month. The performance was measured against both local and national guidance (NICE & BOAST 7). Results Thirty patients were eligible. Thirty-three per cent of patients were appropriately referred to the VFC and ’seen’ within 72 hours. Comparing those referred 63.3% were appropriate, with inappropriate referrals mainly due to false-positive fracture diagnosis or fractures safe to be discharged home. Only 67.8% per cent of patients were managed correctly as per suspected or confirmed diagnosis with regards to fixation (i.e., splint). Conclusions The target of 100% compliance has failed. Fractures deemed safe to be discharged home from the ED are being repeated referred, radiographic interpretations often over-diagnose, and management within the department in sub-optimal. Recommendations include improving junior radiographic interpretation skills and awareness of the local and national guidelines, with another audit cycle to assess for improvement.

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1518 The Use of OrthoPathway, Decision Support Software, To Reduce Variation in Practice, Optimise Patient Care and Reduce Face-To-Face Appointments in Trauma and Orthopaedics

British Journal of Surgery ◽

10.1093/bjs/znab259.1060 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Jones ◽

W Griffiths-Jones

Keyword(s):

Emergency Department ◽

Decision Support ◽

Web Application ◽

Clinical Pathways ◽

Management Plan ◽

National Guidelines ◽

Fracture Clinic ◽

Face To Face ◽

Musculoskeletal Problems

Abstract Introduction Musculoskeletal problems account for 3.5million Emergency Department attendances annually. Front-line staff are under pressure, faced with complex decisions with limited supportive tools. Without adequate support there is greater variation in practice, poor patient outcomes, longer Emergency Department stays and unnecessary follow-up. OrthoPathway is a web application that enables the production of editable decision support pathways. We have published over 50 Consultant designed, locally approved, interactive pathways. Patient-facing staff can use these to follow national guidelines, by answering questions to establish appropriate treatments. Method New and follow-up fracture clinic patients were audited over a one-week period. Clinic letters and clerking documents were analysed to identify the diagnosis and management plan. From information and radiographs available OrthoPathway was used to generate a management plan, used as the audit standard. Results 78 new patients and 83 follow-up patients were seen in fracture clinic over a one-week period. Clinical pathways were available on OrthoPathway for 42% of new patients and 40% of follow-up patients. Variation in practice was seen in 42% of new patients and 59% of follow-up patients. The associated saving in appointments was 11 and 21 and in the new and follow-up patients, respectively. Conclusions We have shown that OrthoPathway has the potential to reduce face-to-face appointments by 20%, with its current utilisation. Through the deployment of a full set of pathways we anticipated a reduction of greater than 40%, which is particularly pertinent given the current COVID-19 pandemic. This highlights the benefits of Consultant approved decision support pathways published on OrthoPathway.

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Fifteen-minute consultation: Assessing the child with an elbow injury

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2018-316129 ◽

2020 ◽

pp. edpract-2018-316129

Author(s):

Sarah Edwards ◽

Damian Roland

Keyword(s):

Emergency Department ◽

Healthcare Professionals ◽

Community Setting ◽

X Ray ◽

Elbow Injury ◽

Elbow Trauma ◽

Elbow Injuries

This article aims to provide a concise summary of the key considerations when assessing a child with an elbow injury. Elbow injuries are common with acute elbow trauma, accounting for 2%–3% of all visits to the emergency department. This article will cover history, examination and key X-ray findings, along with a brief guide to management. It is hoped this article will help healthcare professionals who assess children with elbow injuries. Our work is applicable to those both in the hospital and community setting.

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Virtual fracture clinic delivers British Orthopaedic Association compliance

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0255 ◽

2017 ◽

Vol 99 (1) ◽

pp. 51-54 ◽

Cited By ~ 20

Author(s):

J Holgate ◽

S Kirmani ◽

B Anand

Keyword(s):

Emergency Department ◽

Closed Loop ◽

Waiting Times ◽

District General Hospital ◽

Fracture Clinic ◽

Mean Waiting Time ◽

The Cost ◽

Pro Forma ◽

Virtual Fracture Clinic ◽

British Orthopaedic Association

INTRODUCTION The British Orthopaedic Association recommends that patients referred to fracture clinic are thereafter reviewed within 72 hours. With the aim of improving care by seeking to meet this target, waiting times for fracture clinic appointments in a district general hospital were audited prospectively against this national guideline, with the intervening implementation of a virtual fracture clinic. MATERIALS AND METHODS The study was conducted as a prospective closed-loop audit in which the second cycle took place several months after a change in the clinical pathway for all referrals from the emergency department to fracture clinic. Data were gathered in real-time via a pro forma during fracture clinic consultations. RESULTS The first cycle demonstrated a non-compliant mean waiting time of 10.7 days, with 6% of patients being seen within the 72-hour target. Following the implementation of the virtual fracture clinic, the second cycle found that all patients were reviewed within the 72-hour target (mean 1.3 days). DISCUSSION The improvement in performance was delivered with no increase in clinic capacity. The cost of implementation was negligible. CONCLUSION A simple virtual fracture clinic model delivered a significant reduction in waiting times and achieved compliance with the British Orthopaedic Association guideline. Similar results could be achieved in subsequent deployment elsewhere in the NHS.

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