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T&O consultants running MIU

by Gareth Stables | May 12, 2020 | in Urgent and Emergency Care

Putting our senior decision makers closer to the “front door “ has allowed quicker decisions on definitive treatment for patients with fractures and minor injuries. A significant reduction in unnecessary follow-up appointments, more efficient pathways for patients and massive improvement in training for junior T&O and ED junior team members.

What is needed to sustain the change?

What is your region?

No answer chosen

edited on Jul 13, 2020 by Kyle Beacham
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Will Mason May 12, 2020

Most units have done this And seen these benefits. The challenge is to take this forward into post, at times when elective surgery is back up and running. We would like to use the opportunity of reduced fracture clinic numbers to permanently redeploy a registrar (supported by a Consultant) from fracture clinic to ED minors to act as a senior decision maker.

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Gareth Stables May 12, 2020

Yes reduced numbers needing fracture clinic appointments could free up members of the senior T&O team. We've thought of perhaps merging the fracture clinic and MIU session with support from ED staff and juniors. The senior decision maker could be "consulted" on new patients and see follow-ups too. Plaster room and radiography close at hand (perhaps mini C-arm) could make it more efficient.

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Nick Aresti May 12, 2020

Lots of units are describing good benefits from this type of model. I wonder whether this can be all done remotely? Addenbrooke's for example had a pre-Covid fracture clinic service whereby every referral from A&E was screened by a consultant, meaning reduced numbers of unnecessary appointments and the earlier identification of surgical cases. Niel Kang will be able to shed more light on this....

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Will Mason May 12, 2020

We think that leaving the Minors unit under ED governance would be best though. Only 1/3 of presentations are MSK.

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Niel Kang May 12, 2020

If MIU and moreover, the personnel eg Emergency Nurse Practitioners, were under the umbrella of orthopaedics there would be multiple advantages for emergency care:
Improved patient care and outcomes
1) Reduced follow up for both virtual and face to face fracture clinics
2) more immediate recognition of cases who may benefit from earlier surgery.
3) Greater support & education for ENPs leading to increased job satisfaction, recruitment and retention.
4) enhanced flow in the ED

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Carol McCrum May 13, 2020

Great discussion- Wondering if a physiotherapist along with ENPs could add support to help manage this demand and challenge being discussed - # clinic ( virtual/F2F) & Msk ED presentations- could share some great practice examples of MDT working across a number of NHS Ortho/ED services to help support meeting this challenge

https://www.csp.org.uk/publications/physiothe...ident-emergency

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chris mercer May 13, 2020

thanks Gareth- seems like a popular change and moving VfC and decision makers closer to the front door would help ED pressures as well as patient flow.
Do you have evidence of benefits you can share?

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Gareth Stables May 13, 2020

We're working on pulling together our experience into a presentation at the moment. I'll keep you posted!

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