title: The construction and implementation of a clinical decision-making algorithm reduces the cost of adult fracture clinic visits by up to £104,800 per year: a quality improvement study.
abstract: INTRODUCTION Inappropriate referrals to the new patient fracture clinic unnecessarily consume hospital resources and many hospitals lack clear guidelines as to what should be referred. Many of these injuries can be definitively managed by the emergency department. Our aim was to construct and disseminate a clinical decision-making algorithm to reduce the frequency of inappropriate referrals to fracture clinics at our institution, to improve the management of patients with minor injuries and save the hospital and the patient the cost of unnecessary visits. MATERIALS AND METHODS Data were prospectively collected for all new fracture clinic referrals over two separate 1-week cycles with cohorts of 94 and 74 patients, respectively. After the first cycle, the referral algorithm was disseminated both electronically (intranet) and orally (presentations to emergency department staff). The results of this intervention were examined in the second cycle, which took place 6 months after the first cycle. RESULTS The introduction of this algorithm significantly reduced inappropriate referrals by almost 20% (P = 0.0445). DISCUSSION This simple intervention highlighted a potential annual cost saving of up to £104,000. We advocate the use of this concise algorithm in improving the efficiency of the referral system to fracture clinics.
authors.affiliation: Derby Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: P
authors.initials: P
authors.lastname: Legg
authors.affiliation: Derby Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: D
authors.initials: D
authors.lastname: Ramoutar
authors.affiliation: Derby Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: F
authors.initials: F
authors.lastname: Shivji
authors.affiliation: Derby Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: B
authors.initials: B
authors.lastname: Choudry
authors.affiliation: Derby Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: S
authors.initials: S
authors.lastname: Milner
mesh_terms: D000328:Adult; D000465:Algorithms; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D017046:Cost Savings; D004636:Emergency Service, Hospital; D050723:Fractures, Bone / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D004204:Joint Dislocations / Q000628:therapy; D000069342:Medical Overuse / Q000191:economics / Q000517:prevention & control*; D009140:Musculoskeletal Diseases / Q000628:therapy*; D009985:Orthopedics / Q000191:economics; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D058996:Quality Improvement; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data*; D013180:Sprains and Strains / Q000628:therapy; D013222:State Medicine; D006113:United Kingdom
keywords: Cost effectiveness; Fracture clinic; Referral algorithm