PT  - JOURNAL ARTICLE
AU  - Natarajan, U
AU  - Gilbert, J
AU  - Gardner, S
TI  - G286(P) Audit of virtual orthopaedic consultation from paediatric accident and emergency through e-folder
AID  - 10.1136/archdischild-2017-313087.280
DP  - 2017 May 01
TA  - Archives of Disease in Childhood
PG  - A112--A113
VI  - 102
IP  - Suppl 1
4099  - http://adc.bmj.com/content/102/Suppl_1/A112.3.short
4100  - http://adc.bmj.com/content/102/Suppl_1/A112.3.full
SO  - Arch Dis Child2017 May 01; 102
AB  - 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.Was the process safe?Demographic profile of children referredOutcome of referralMethods 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. Understandingdemographics 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.