title: Delay to orthopedic consultation for isolated limb injury: cross-sectional survey in a level 1 trauma centre.
abstract: OBJECTIVE
  To describe referral mechanisms for referral to orthopedic surgery for isolated limb injuries in a public health care system and to identify factors affecting access.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Orthopedic surgery service in a level 1 trauma centre in Montreal, Que.
  
  
  METHODS
  We conducted a prospective study of 166 consecutive adults (mean age 48 years) referred to orthopedic surgery for isolated limb injuries during a 4-month period.
  
  
  METHODS
  Self-reported data on the nature of the trauma, the elapsed time between injury and orthopedic consultation, the number and type of previous primary care consultations, sociodemographic characteristics, and the level of satisfaction with care.
  
  
  RESULTS
  Average time between the injury and orthopedic consultation was 89 hours (range 3 to 642), with an average of 68 hours (range 0 to 642) for delay between primary care consultation and orthopedic consultation. A total of 36% of patients with time-sensitive diagnoses had unacceptable delays to orthopedic consultation according to the Quebec Orthopaedic Association guidelines. Lower limb injury, consulting first at another hospital, living far from the trauma centre, patient perception of low severity, and having a soft tissue injury were associated with longer delays.
  
  
  CONCLUSIONS
  Identifying gaps and risk factors for slower access might help improve referral mechanisms for orthopedic consultation.
authors.affiliation: Hôpital du Sacré-Coeur, Orthopedie, Montreal, QC H4J 1C5. dominique_rouleau@yahoo.ca
authors.forename: Dominique M
authors.initials: DM
authors.lastname: Rouleau
authors.forename: Debbie Ehrmann
authors.initials: DE
authors.lastname: Feldman
authors.forename: Stefan
authors.initials: S
authors.lastname: Parent
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001134:Arm Injuries / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007869:Leg Injuries / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000706:statistics & numerical data; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D055815:Young Adult