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#NHSChangeChallenge

Urgent and Emergency Care

29 Ideas
23 Votes
116 Comments
60 Subscribers

Please outline key innovations, changes and developments in the way you have delivered unplanned care during the coronavirus pandemic.

If you are a clinician, what has worked well and made a positive impact on the patient journey or your ability to deliver an acute trauma service?

Ideas around adult and paediatric injury management, delivery of the acute take, urgent surgery and fracture clinic, and system and process management are all welcome, to name but a few. If you are a patient, who has recently received treatment for a musculoskeletal injury in an NHS hospital, we would love to hear your views on what worked well during the period when you received your care.

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  1. Alex Trompeter
    249 pts
  2. Niel Kang
    142 pts
  3. Gareth Stables
    110 pts
  4. Alex Buckley
    102 pts
  5. OrthoBarry
    69 pts

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Horizon 1

Tele-referral for trauma

The referral of trauma cases including compound fractures and burn injury by Emergency Departments often results in the unnecessary transfer of patients for visual assessment. A pilot running with all Manchester Emergency Departments for the last three years has demonstrated the benefits of secure image tele-referral in reducing unnecessary transfers and rationalising the delivery of trauma-based services. Despite the burn injury version of the system being centrally funded for national...

6.5 Points
3
Horizon 2

Stopping of the routine check x-ray post hip hemiarthroplasty for intra-capsular neck of femur fractures

1 - Safe and sustainable practice 2 - Reduced demand on radiology departments 3 - Reduced demand on nursing / portering staff 4 - Cost saving for the trust 5 - Potential for reduced transmission of airborne / droplet infection around the hospital Having audited our last 3 years data, including 960 hemiarthroplasties, we noted that the rate of complications picked up on the check x-ray was just 0.1% (1 case of dislocation) and within our overall 1.25% complication rate, the vast...

2
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Horizon 3

Allocation of Mini C arm to Fracture Clinic

During the peak of the Covid19 crisis, we were allocated a Mini C arm, to help us support the urgent treatment centre, which had had been integrated into fracture clinic. This enabled a specific clinic Ortho SPR in tandem with a qualified Orthopaedic Technician, to perform an MUA in plaster room under haematoma block and gas & air on the day of first attendance to the emergency department 'Same Day Fracture Service'. The result of this was more effective MUA for patients, using less...

3.5 Points
4
Horizon 3

Physiotherapy Staff in MIU

Prior to covid-19 pandemic, patients who had sustained MSK trauma, and visited ED, would be referred to physiotherapy for appropriate walking aid, and follow up rehab.  They would be transported to the physio department, get their walking aid, and then go on an urgent waiting list for physiotherapy to come back within 5 days. From the onset of covid-19, a minor injury unit (MIU) has been established, currently managed by orthopaedic consultants, and with physiotherapy cover 9am-9pm, 7 days...

8.5 Points
4
Horizon 3

East Lancashire Paediatric Physio management within UCC and MIU

Developed patient advice and self-management leaflets pertinent to the Paediatric population and worked with colleagues in ELHT UCC on a new pathway for management and referral into our service. The right information received at UCC has meant that patients have been able to recover without receiving an unnecessary follow up physiotherapy appointment.  This has improved patient care, treating patients at an appropriate time with effective, evidence-based information.  Patients are given...

6.5 Points
3
Horizon 1

Early on in the pandemic all orthopaedic consultants and registrars were given Remote Desktop access.

This has meant that during 24hr non resident on calls imaging from AE can be easily and safely discussed as well as then between consultant and registrar without the need for sending potentially low quality and small imaging over WhatsApp. This has been of great benefit for orthopaedics and ED staff as well as patients. 

6.5 Points
5
Horizon 2

Better care for wrist fractures

All wrist fractures that attend the Minor Injuries Unit that are displaced are being discussed with the orthopaedic consultant who is present in fracture clinic in the same corridor. If manipulation is needed, it is done in the plaster room using a mini-C-arm X-ray machine by an orthopaedic consultant or senior orthopaedic trainee and a good quality cast applied by the plaster technician. This addresses several issues: 1. decision about whether or not to manipulate 2. availability of...

4.5 Points
6
Horizon 2

AP Physio Led UCC/ED Returns clinic

Covid - 19 has affected all MSK pathways not only in primary care but out of secondary care as well. A group of patients that UCC would normally pass into specialist MSK services has now got to self manage without that monitoring and rehabilitation service in place.   I aimed to help set up a clinic that could manage all significant soft tissue injuries in a single point of contact, allowing for advanced clinical reasoning and expert pathway knowledge to minimise patient anxiety and...

7 Points
4
Horizon 1

Proposed AP MSK Physio led ED returns clinic / Ortho

Improved patient journey. Minimised/ reduced the need to attend ortho clinics, enhanced clinical decision making for MIU. Ortho Consultants worked in MIU alongside ENP‘S and MSK Physio Practitioners. Senior decision making at the time of patient presentation reduced referrals to virtual fracture clinic, freeing up Consultant time and reducing often unnecessary clinic attendance for patients. Collaborative working  has  showcased the high level of clinical skills and expertise of the ENP’s...

7 Points
4
Horizon 2

AP Physio Led MIU

We moved the MIU away from the ED footprint (still on site within Orthopaedics) to reduce the volume of patients in ED.  Our advanced practice physio teams from ED/Orth and Spines staffed the unit 6am-midnight, Orth fracture clinic support staff and nurses provided treatments, meds etc to allow ED team to focus on majors.  Orth reg worked as part of the team seeing Orth cases only and complex Orth cases were discussed with a Consultant rather than junior.  Manipulations were done using...

7 Points
6
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