• J Vardy, L Rymaszewski, K Begbie, I Anthony, M Chekroud, K Clark, and A J Ireland.
• Emergency Department, Glasgow Royal Infirmary, Glasgow, United Kingdom.
• Emerg Med J. 2013 Oct 1;30(10):876.

Objectives & BackgroundThe Redesigned Fracture Pathway has revolutionised fracture management, decreased orthopaedic workload and improved the patient journey. The Pathway consists of guideline driven treatment of patients with fractures. There is no follow up for many stable injuries, virtual review of other fractures and orthopaedic registrar referral for admission decisions. Many discharged patients never receive a clinic appointment necessitating the development of discharge information leaflets and a move from plaster casts to Velcro splints. Have orthopaedics simply passed their workload onto the Emergency Department? 1) Patients with fractures are discharged with no follow up, does this necessitate longer consultations in ED? 2) Without routine follow up do patients simply pitch back up to ED? 3) Has the admissions process actually improved?MethodsWe examined length of consultations, unplanned reattendances to ED within 7 days, number of Orthopaedic admissions and time from first assessment to admission before and after Fracture Clinic Redesign.Results1) Length of consultation was unchanged for discharges without follow up, (p=0.316, 0.508, 0.571). Consultations were shorter when splints replaced casts, (p=0.046, 0.588, 0.032). 2) Unplanned reattendances within 7 days did not increase as a proportion of ED attendances, (p=0.779). 3) Orthopaedic admissions fell by 7.9% and time from first assessment to admission by 9.6% per annum (p=0.002, p=0.011). Orthopaedic breaches decreased significantly, (p<0.001).ConclusionDirect discharges from ED do not require longer consultations nor do they return to ED. Orthopaedic admission is increasingly efficient and breaches are down. Is Fracture Pathway Redesign good for the Emergency Department? Yes!

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