title: The effect of training on fracture clinic efficiency and patient access.
abstract: OBJECTIVE
  The aim of this study was to assess the effect of education and use of a referral protocol on fracture clinic referral pathways, function, and patient care in the emergency department.
  
  
  METHODS
  At Craigavon Area Hospital, a district general hospital, 58 new patient referrals were reviewed by the attending orthopedic surgeon at the fracture clinic. Each case was reviewed with regards to diagnosis, appropriateness of review time, and actual review time. Following this, the senior author performed a 1-hour teaching program in the ED utilizing a referral protocol. The study was then repeated in 63 patients to evaluate any improvement in patient treatment.
  
  
  RESULTS
  Following the teaching program, a statistically significant improvement was found in interpretation of protocol (p=0.02), review time suggested (<0.00), and proportion of patients that actually receive an appropriate review time (p=0.004). No significant change was found with regards to grade of ED clinician referring the patient.
  
  
  CONCLUSIONS
  The use of a simple education program and referral protocol may provide a significant improvement in appropriateness of patient referrals in the emergency department. This leads to a significant increase in patients referred with correct diagnoses, timeliness of review times, and subsequently improved patient care.
authors.affiliation: Craigavon Area Hospital, Department of Orthopaedics and Traumatology, Northern Ireland. gjheyes@live.co.uk.
authors.forename: Gavin John
authors.initials: GJ
authors.lastname: Heyes
authors.affiliation: Craigavon Area Hospital, Department of Orthopaedics and Traumatology, Northern Ireland.
authors.forename: Jim
authors.initials: J
authors.lastname: McConway
mesh_terms: D002985:Clinical Protocols; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006769:Hospitals, General; D006801:Humans; D008503:Medical Staff / Q000193:education*; D009660:Northern Ireland; D005791:Patient Care / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards*