Article Text

G286(P) Audit of virtual orthopaedic consultation from paediatric accident and emergency through e-folder
  1. U Natarajan,
  2. J Gilbert,
  3. S Gardner
  1. Paediatric Accident and Emergency, Southport and Ormskirk Hospital NHS Trust, Ormskirk, UK


Aims Difficulties in communication between Orthopaedic on call and Paediatric Accident and Emergency (A and E) clinicians due to split site, prompted virtual consultation via e-folder. (Orthopaedic doctor not available on Paediatric A and E site to review patient; senior orthopaedic input not available for all patients) A shared orthopaedic e-folder, set up as an iterative Quality improvement programme to facilitate and streamline orthopaedic referrals from Paediatric A and E, was reviewed.

  1. Was the process safe?

  2. Demographic profile of children referred

  3. Outcome of referral

Methods Paediatric A and E clinician inputs into the shared folder (set up as columns), patient demography, mechanism and nature of injury, clinical findings. These details along with X-ray are reviewed in Orthopaedic consultant-led trauma meeting following day and management plan communicated via e-folder, which is actioned by Paediatric A and E clinician by 9 AM. The e-folder data were analysed retrospectively for a 12 month period of January to December 2015.

Results 283 children were referred for virtual consultation through shared e-folder (1% A and E attendances). Date of birth of patient was missing in six; name and GMC/NMC number of clinician was available only in 38.9%. 161 cases (57%) were discussed over the phone with orthopaedic on call in addition to ereferral. Orthopaedic referrals peaked during June – October. Radius, radius and ulna, humerus, and elbow fractures were most common. Trauma meeting outcome: 192 cases were reviewed in fracture clinic within one week. Surgery was planned in 40 (manipulation under anaesthesia alone or plus K-wire/ORIF); 40 cases needed other procedures/conservative management; outcome was not recorded in 11 cases. Tertiary centre consultation/ referral was made in 9 cases only.

Conclusion Clinical information provided in the folder (columns) was adequate in streamlining referrals. Documentation was good. Recording of name, GMC number of Paediatric A and E/Orthopaedic clinician requires improvement. Understanding

demographics will help in arranging targeted services and education. Majority of cases were dealt with locally, only a few requiring tertiary hospital consultation/referral. Virtual consultation via shared folder has shown to be an effective quality improvement programme in a setting of split site services. It provides consultant-led decisions in a timely fashion for all children referred.

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