Trauma and Orthopaedic Surgery Specialist Registrar, Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, EH16 4SA, UK.
Trauma and Orthopaedic Surgery Specialist Registrar, Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, EH16 4SA, UK.
Surgeon. 2023 Dec;21(6):e367-e371. doi: 10.1016/j.surge.2023.07.005. Epub 2023 Aug 26.
Traditionally it has been the case for orthopaedic consultants to review GP referrals for the orthopaedic outpatient clinic where possible in amongst other clinical commitments. This could sometimes lead to unsuitable patients being reviewed and both patients and clinicians becoming frustrated. Building on the virtual fracture clinic, a new screening tool was implemented to streamline new referrals. The aim of this study is to investigate the change in patients given outpatient appointments following the introduction of a new streamlining protocol.
Referrals had to meet the criteria of BMI under 40 or evidence of weight loss effort, recent radiographs and appropriate clinical details in keeping with Getting It Right First Time (GIRFT). Consultant were given dedicated clinical time to review and either triage the patient to the most appropriate clinic type, or return the referral with advice to the GP. 10 months of data was collected prior to the protocol and 10 months after implementation.
1781 patients were referred pre-protocol with an average of 14.2% of these being returned. Post protocol there were 2110 patients referred with 31.2% returned. There was an increase in 195% of referrals returned to the GP (p < 0.0001). The highest proportion of these was for mild to moderate osteoarthritis on the radiograph which has been proven to be unsuitable for intervention. At 12 month analysis there was no significant increase in patients re-referred to the service (p = 0.53) DISCUSSION: The new screening tool allows more appropriate referrals to be seen in clinic allowing less frustration to clinicians and patients by reducing therapeutic inertia. Furthermore it allows new referrals to be seen by the most appropriate sub-specialist. It allows advice to be given to GPs on further management for the patient. 619 appointments were saved. At a cost of £120 per appointment, this leads to a real terms cost saving of £74,280, with further savings in time and travel.
传统上，矫形外科顾问会在其他临床工作之余，尽可能地审查 GP 转介的矫形外科门诊患者。这有时会导致不合适的患者被审查，患者和临床医生都会感到沮丧。在虚拟骨折诊所的基础上，引入了一种新的筛选工具来简化新的转介。本研究旨在调查引入新简化方案后，获得门诊预约的患者发生的变化。
转介必须符合 BMI 低于 40 或有减肥努力的证据、最近的射线照片和与一次正确（Getting It Right First Time，GIRFT）相符的适当临床细节的标准。顾问会有专门的临床时间来审查患者，并将患者分诊到最合适的诊所类型，或根据建议将转介返回给 GP。在实施该方案之前收集了 10 个月的数据，之后又收集了 10 个月的数据。
在方案实施前，有 1781 名患者被转介，其中平均有 14.2%被退回。方案实施后，有 2110 名患者被转介，其中 31.2%被退回。返回给 GP 的转介增加了 195%（p<0.0001）。其中最多的是放射照片上轻度至中度骨关节炎，这种疾病不适宜干预。在 12 个月的分析中，没有显著增加患者重新转介到该服务（p=0.53）。
新的筛选工具允许更多合适的患者在诊所就诊，通过减少治疗惰性，减少临床医生和患者的挫败感。此外，它允许新的转诊患者由最合适的亚专科医生就诊。它允许向 GP 提供有关患者进一步管理的建议。节省了 619 个预约。按每次预约 120 英镑计算，这将节省 74280 英镑的实际成本，同时还节省了时间和旅行成本。
