Abstract
Current fracture-clinic models, especially in the advent of reductions in junior doctors hours, may limit outpatient trainee education and patient care. We designed a new model of fracture-clinic, involving an initial consultant led case review focused on patient management and trainee education.
Outcomes for all new patients attending the redesigned fracture-clinic over a 3-week period in 2010 were compared with the traditional clinic in the same period in 2009. Health professionals completed a Likert questionnaire assessing their perceptions of education, support, standards of patient care and morale before and after the clinic redesign.
309 and 240 patients attended the clinics in 2009 and 2010 respectively. There was an increase in consultant input into patient management after the redesign (29% versus 84%, p<0.0001), while the proportion of patients requiring physical review by a consultant fell (32% versus 9%). The percentage of new patients discharged by junior medical staff increased (17% versus 25%) with a reciprocal fall in return appointments (55% versus 40%, p<0.0005). Overall, return appointment rates fell significantly (55% versus 40%, p=0.013). Staff perception of education and senior support improved from 2 to 5, morale and overall perception of patient care from 4 to 5.
Our model of fracture-clinic redesign has significantly enhanced consultant input into patient care without additional funding. In addition, we have demonstrated increased service efficiency and significant improvements in staff support, morale and education. In the face of current economic and training challenges, we recommend this new model as a tool for enhancing patient and trainee experiences.
