Abstract
Introduction
Ashford and St Peter's Hospital (ASPH) is a district general hospital in Chertsey, Surrey. It is a tertiary referral unit offering a circular frame service to manage complex trauma patients in the South East of England.
This study analyses the patient pathway in 66 consecutive tertiary referrals from 2015–2020. All patients were managed with an Ilizarov frame for either a tibial plateau fracture or pilon fracture.
Materials and Methods
The patient journey of 66 consecutive tertiary referrals for tibial plateau and pilon fractures were analysed. The following data was captured: patient demographics; type of injury; referring centre; date of injury; date of referral; date of arrival at ASPH; date of surgery and date of discharge. Using this data we aimed to identify areas of the pathway that can be improved.
In addition, the 66 patients were split into two groups of 33 patients. 33 patients were referred via an electronic referral platform and 33 patients were referred verbally prior to the implementation of the electronic referral platform. The groups were compared to see the impact of an electronic referral platform on the patient's journey.
Results
Average age 45 (range 17–88 years), Male percentage 54.55%, 45 tibial plateau patients, 21 pilon patients.
Injury to Admission at ASPH- 6 days (median), Injury to Surgery 8 days (median), Surgery to Discharge 4 days (median), Total stay in ASPH 6 days (median)
Conclusions
The biggest delay in our tertiary referral pathway is from referral to arrival at ASPH. The implementation of an electronic referral pathway has not improved times from referral to arrival at ASPH. Ring fenced beds for tertiary referrals would be the greatest way to improve flow through the pathway and reduce the complications related to delayed surgery.
