Abstract
Introduction Knee injuries are a common presentation to Accident and Emergency departments. Often many injuries that are referred are minor as a result of the difficulty in initial assessment, and cause an unnecessary increase in workload in Orthopaedic clinics. The purpose of this study was to evaluate current practice at our Knee Injury Clinic and to implement changes to make the service more efficient and effective. It forms a completed audit cycle of current practice.
Material and methods Part I: We assessed all referrals from our Accident & Emergency department in two separate 4 month periods to the Acute Knee Injury Clinic according to the following criteria (which need fulfilling for referral)-
Recent history of injury associated with one or more of the following:
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Acute haemarthrosis
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Clinical instability
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Disproportionate pain
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Locking
Referrals were assessed as fulfilling or not fulfilling the criteria, and also as to the ultimate diagnosed pathology.
Part II: From the results of these two audits, a multidisciplinary treatment proforma was created and distributed to Accident and Emergency. This included physiotherapy as a primary treatment option. Referrals were then reassessed as in the previous audits for a 4-month period.
Results and conclusions The Acute Knee Injury Pro-forma resulted in a 15% reduction in referrals not fulfilling the criteria (p=< 0.05). This equates to a reduced workload due to inappropriate referrals, while significant injuries such as Cruciate rupture are picked up due to the sensitivity of the criteria.
There was a significant increase in patients referred directly from Accident and Emergency to the physiotherapy department, which means minor injuries receive physiotherapy earlier than if they initially came to clinic.
The proforma was well received by the junior doctors in Accident and Emergency due to its simplicity.
Overall the use of the proforma has improved the standard of care at our unit.
Correspondence should be addressed to Roger Smith, Honorary Secretary, BASK c/o Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, London WC2A 3PN
