Primary care pathway - A novel way to reduce the burden on orthopaedic fracture clinics within the pediatric subgroup: A Queensland multi-centered review

Abstract

Emergency departments receive an increasing amount of musculoskeletal injuries, with the majority referred to a fracture clinic (FCs). A literature review revealed certain orthopaedic injuries can be safely managed away from the FC pathway by general practitioners (GPs) or allied health professionals (AHPs). The present study aims to review all paediatric presentations to FCs at 2 Queensland hospitals, identifying low risk injuries that could potentially be managed by GPs or AHPs. This study is a continuation from Cleary et al in which a primary care pathway (PCP) was proposed for the management of low risk adult orthopaedic injuries. A PCP has the potential to have significant savings to the health system. A retrospective study was conducted looking at paediatric patients (<16 years) referrals to 2 FCs over 8 weeks. Injuries were categorised into those requiring FC care supervised by an orthopaedic surgeon, and those that can be safely managed by GPs or AHPs via a PCP. Four hundred ninety (57.7%) of the 849 patients referred to FC were assessed as suitable for PCP care. The most common upper limb injury deemed suitable was radius and ulna buckle fractures (18.4%), while the most common lower limb injury is ankle sprains (8%). Total failure to attend rate in the PCP group was 6.7%. Adopting the PCP has the potential to significantly reduce FC referrals. With proven success of similar pathways abroad, the PCP may generate significant time and financial savings for both the health care system and patient. Abbreviations: AHP = allied health professionals, ED = emergency department, FTA = fail to attend, FC = fracture clinic, GP = general practitioners, GRI = Glasgow royal infirmary, PCP = primary care pathway.