Impact of an Orthopedic-Delivered 'One-Stop' Clinic for Ambulatory Trauma on Emergency Department and Fracture Clinic Pressures During the COVID-19 Pandemic

Abstract

Introduction: In March 2020, the World Health Organization declared the severe acute respiratory syndrome (SARS) (coronavirus disease, COVID-19) outbreak as a pandemic. In response to the rising number of coronavirus cases in the United Kingdom, the British Orthopaedic Association (BOA) issued a series of emergency guidelines for the management of trauma and orthopedic patients during the pandemic. In line with this guidance, the orthopedic team at the Worcestershire Royal Hospital set up a 'one-stop-shop' minor injuries unit (MIU). This seven-day service provided a direct pathway to the trauma clinic for ambulatory patients who would usually be managed in the emergency department (ED), intending to reduce both the pressure on the ED and the need for further follow-up appointments. The aim of this project was to evaluate the service provided to patients and to inform our practice during the next stages of the pandemic and beyond.

Materials and methods: Data were collected retrospectively from a clinic database, dictated letters, and scanned patient notes. The data collection period was over six weeks from April 6, 2020 to May 18, 2020. Data collected included patient age and gender, time of arrival and departure, grade of reviewing clinician, diagnosis, treatment, and outcome of clinic attendance, including the timing of follow-up.

Results: Some 700 patients were seen in the MIU over six weeks. Some 98% of patients were seen by an orthopedic registrar (resident) or a consultant (attending) and 85% were seen and treated within an hour. Some 71% of patients were discharged after their initial appointment, and only nine patients (1%) required a fracture clinic appointment within 72 hours. A total of 15 patients (2%) re-attended with concerns, and just four of these required additional interventions.

Conclusions: We delivered a seven-day minor injuries service in which the majority of patients received definitive management at first attendance, reducing the demand for fracture clinic appointments. Some 700 patients who would have been treated in the ED were seen in the MIU instead, relieving pressure on the ED. The lessons learned allowed us to plan for the 'second peak' in COVID-19 cases and will inform ongoing practice as we work to recover elective services.

Keywords: coronavirus; covid-19; fracture clinic; minor injuries; trauma.

Figure 1. Bar chart showing the time spent in the department

Figure 2. Bar chart showing clinic outcome following MIU consultation, including any follow up planned

MIU, minor injuries unit

Figure 3. Bar chart showing method of immobilization for patients with confirmed fracture