Trauma Assessment Clinic
Our Lady’s Children’s Hospital Crumlin. The Trauma Assessment Clinic project
Introduction: The Trauma Assessment Clinic (TAC) offers rapid, consultant delivered follow up for children with non-operative fractures diagnosed in the Emergency department at Our Lady’s Children Hospital Crumlin without a requirement for further hospital visits.
Objectives: The primary objective of TAC is to provide Early Definitive Care (EDC) for a range of non-complicated paediatric injuries at the time of presentation to the emergency department. The TAC allows EDC to be performed in a safe setting. The provision of EDC should result in reduced patient visits to the hospital, offering an opportunity for significant financial savings and reduced wait time for children requiring time sensitive orthopaedic follow up. Secondary objectives were to maximise efficient communication and increase clinical training opportunities available to both paediatric emergency medicine (PEM) and orthopaedic staff.
Implementation Tactics and Strategy: It was recognised that the demand for time sensitive trauma clinic appointments exceeded the capacity of the service. A working group was established involving medical, nursing, Health and Social Care Professionals and administrative members of the Orthopaedic, PEM, Physiotherapy, Outpatient and operational services teams. A review of international best practice identified successful precedents in other jurisdictions. A cohort of patients suitable for EDC in the emergency department were agreed by the Orthopaedic and Emergency consultant teams. A model was developed which offered safe, timely, quality specialist follow up for all patients. Added staff training and fracture immobilization resources were placed to allow EDC on initial interaction with the patient. A suite of supporting documentation was developed for parents and clinicians. A robust system of ongoing monitoring and iterative quality improvement was adopted. PEM and orthopaedic staff are concurrently rostered to the TAC to maximise efficient communication and training.
Outcomes: To date, over an eleven month period, 1454 children have been assessed via the TAC clinic. 65% of whom have been safely discharged without a requirement of OPD visit. 35% received a follow up appointment in a “face to face” fracture clinic. This represents 948 clinic appointments saved by use of the “virtual clinic” route.
This saving of clinic slots has reduced wait times for new referrals to fracture clinic from an average of 40 days pre implementation of TAC to 7 days post implementation of TAC. A reduction in the rate non-attendance at the fracture clinic from 15% to 9% was observed over the implementation time period.
Patient satisfaction is reported to be high and the ED has received no complaints relating to management of patients with fractures since introduction of the TAC.
The TAC at OLCHC is the first virtual paediatric trauma clinic in Ireland. This innovative model delivers high quality, timely care which benefits, patient, parent and institution.