Paediatric fracture clinic design--current practice and implications for change

Area of Science:

• Pediatric Orthopedics
• Healthcare Management
• Clinical Efficiency

Background:

• Adult fracture clinic redesigns have shown success.
• Paediatric fracture clinics face challenges with attendance load and efficiency.
• Assessing paediatric fracture clinic load is crucial for optimizing patient flow.

Purpose of the Study:

• To define the patient load of a paediatric fracture clinic.
• To evaluate the feasibility of reducing inappropriate attendances to improve clinic efficiency.

Main Methods:

• Prospective review of case notes for consecutive attendances at 6 paediatric fracture clinics.
• Analysis of attendance appropriateness, diagnoses, interventions, and imaging rates.
• Calculation of discharge to return ratios for appropriate and overall attendances.

Main Results:

• 15% of 234 attendances were deemed inappropriate.
• Appropriate attendances (n=200) involved fractures, soft-tissue injuries, infections, and limps.
• High rates of treatment plan changes (34%), cast manipulations (46%), and radiographs (77%) were observed for appropriate attendances.

Conclusions:

• Stricter referral criteria, including emergency department discharge for specific fractures, can decrease paediatric fracture clinic numbers by 15%.
• Remaining attendances demonstrate high rates of necessary radiographs and interventions.
• Further reductions in attendance for appropriate cases are unlikely to be feasible without impacting care.