title: The evolution of fracture clinic design : the activity and safety of the Edinburgh Trauma Triage Clinic, with one-year follow-up.
abstract: OBJECTIVE
  Fracture clinics are often characterised by the referral of large numbers of unselected patients with minor injuries not requiring investigation or intervention, long waiting times and recurrent unnecessary reviews. Our experience had been of an unsustainable system and we implemented a 'Trauma Triage Clinic' (TTC) in order to rationalise and regulate access to our fracture service. The British Orthopaedic Association's guidelines have required a prospective evaluation of this change of practice, and we report our experience and results.
  
  
  METHODS
  We review the management of all 12 069 patients referred to our service in the calendar year 2014, with a minimum of one year follow-up during the calendar year 2015.
  
  
  RESULTS
  Following the successful introduction of the TTC, only 2836 patients (23.5%) who would previously have been reviewed in the general fracture clinic were brought back to such a clinic to be seen by a surgeon. An additional 2366 patients (19.6%) were brought back to a sub-specialist injury-specific clinic. Another 2776 patients (23%) with relatively predictable injuries were reviewed by a nurse practitioner according to an established protocol or specific consultant instructions. A further 3222 patients (26.7%) were discharged from the service without attending the clinic. No significant errors or omissions occurred with the introduction of the TTC.
  
  
  CONCLUSIONS
  We have found that our TTC allows large numbers of referrals to be reviewed and triaged safely and effectively, to the benefit and satisfaction of patients, consultants, trainees, staff and the organisation. This paper provides the first large-scale review of the instigation of a TTC, and its effect, acceptability and safety. Cite this article:Bone Joint J2017;99-B:503-7.
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, UK.
authors.forename: T O
authors.initials: TO
authors.lastname: White
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Mackenzie
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, UK.
authors.forename: T H
authors.initials: TH
authors.lastname: Carter
authors.affiliation: Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK.
authors.forename: J G
authors.initials: JG
authors.lastname: Jefferies
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, UK.
authors.forename: O R
authors.initials: OR
authors.lastname: Prescott
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Duckworth
authors.forename: J F
authors.initials: JF
authors.lastname: Keating
mesh_terms: D005160:Facility Design and Construction; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000628:therapy*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D009936:Organizational Innovation; D009985:Orthopedics / Q000458:organization & administration*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data; D012449:Safety; D012606:Scotland / Q000453:epidemiology; D014193:Trauma Centers / Q000458:organization & administration*; D014218:Triage / Q000458:organization & administration*
keywords: Fracture clinic redesign; Trauma Triage Clinic