Fracture Clinic Booking Directory

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The expectation and good practice would be that the Ortho team in the Emergency Department to refer to Ortho on call team here at Alder Hey to arrange Fracture Clinic appointment and images would be linked via an Image Exchange Portal (IEP) to the Picture Archiving Communication System (PACS) (if not able to the patient would need to bring a CD of images) with this a faxed / email referral to on call consultant PCO to arrange # clinic appt and to be discussed at handover with on call consultant.

For all Orthopaedic Tertiary referrals the Trust asks the referring hospital to refer via this form.  This is for both adults and paediatrics; however, referrals for the latter are very infrequent.  The on-call Orthopaedic Consultant will review the referral and accept or reject.    Rejections are very rare.

Tertiary referrals cover two main categories:

• Patients who live locally, have an accident elsewhere and receive initial Orthopaedic treatment at another hospital, and then transferred to us (their local hospital) for ongoing Orthopaedic Treatment / rehabilitation.
• Patients who are not local but are referred to ASPH for specialist surgery as we are a regional complex fracture centre.   We normally operate and when stable transfer them back to their local hospital.

The patient’s GP needs to arrange this.

The service would require a referral . If it was from an NHS hospital then it would be an inter hospital transfer form requesting a transfer with all the clinical details, demographics etc. Imaged would need to be sent electronically.,

A referral from a GP would need to go via MSK services if it was from primary care.

There are three ways where patients are referred to us for follow ups following trauma surgery at another hospital:

1. Polytrauma patients are referred via our ‘refer a patient’ system where all injury details, surgery dates and required follow up can be documented. This also prompts them to send all relevant imaging in time for review.
2. The Registrar at the referring hospital refers to the on-call Registrar over the phone for single injuries. These should be encouraged to be over ‘refer a patient’ to enable a written record.
3. Patients are able to self-present to A&E to request follow up with us.

The process would be for a discharge summary to be provided to the patient and their GP by the hospital and it would be the patient’s GP who would then arrange any follow up care required in the patients local area.

Some referring hospitals send letters, we would see in an appropriate clinic. Some hospitals send a letter with a patient to see their GP or local unit ED who arrange a fracture clinic follow up directly. Slowest is via a GP.

We respond to the individual in ED if they present with no letter and pass through a VFC most likely.

Invariably there are no blockers we would not refuse a patient who has no letter, most patients present themselves with a letter to ED asking for access to the fracture clinic system. It’s often quicker than a direct letter from the index hospital.

If the patient attends A&E only and then wishes to receive further care at our Trust, the patient would be given a copy of their X-rays on a CD and A&E documentation from the A&E department they attended, This would then be taken to their GP or the walk in centre to request a further appt at our Orthopaedic clinic.

The child’s parents/carer should be given the xrays/A&E documentation from the  hospital that they attend at and they will then either go to their GP surgery or the walk in centre with these documents.

The requirements in terms of the referral process would be as follows.

1. Telephone referral to Orthopaedic junior doctor on call via switchboard with relevant information and contact details for the patient (Hospital switch board number is 01204 390 390).
2. Ensure all images are transferred via PACS to our system (failing that, patient given electronic copy). We can ask our PACS team to pull images however in the interest of swiftness would requested that images are pushed from the referring hospital PACS team to our organisation.
3. Discharge letter from referring trust outlining presentation, treatment received and operation note if applicable – given to patient/posted/emailed to [email protected]

The referral should go to any Consultant within the correct sub-speciality (e.g: foot & Ankle, Arthroplasty, Shoulder) or to virtual fracture clinic which would then be triaged to face to face fracture clinic if needed or to elective clinic.

Onward outpatient referral from the hospital that did the initial treatment. If it is an inpatient then they would liaise with our hospital and consultant via the clinical site team to transfer back.

Bradford Teaching Hospitals NHS Foundation Trust does not manage Trauma and Orthopaedic Paediatrics – this is managed by Leeds Teaching Hospitals within our region.

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The treating team elsewhere can contact our on-call team and they take the details to be discussed with seniors and appropriate follow-up put in place. This is appropriate for urgent cases or those requiring operations on return to our region. The patient can attend Emergency Department and they will refer to orthopaedics as per our local policy.

The patient is referred to us via their GP, the referral is triaged, and appropriate follow-up appointment made. In addition, GP’s have access to a VFC referral for urgent trauma cases needing ongoing no operation management or post operation care.

The patient would phone the local Emergency department reception who if thought patient who sustained injury out of area needed urgent review would ask them to attend the local ED for review or if not needed to be seen for an urgent appointment would be made by ED receptionist an appointment in a face to face fracture clinic within 3 days.

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If a Fulham patient has had an injury elsewhere and needs following up at CW – they would come as a new patient with an onward referral from the hospital where the injury was treated. This referral would be either to the fracture clinic for an acute injury or to a normal ortho clinic if it was for ongoing care.

The Referral hospital should send a letter (or email) to the fracture clinic at the hospital the patient would like to be seen and the team will then book the most appropriate appointment. 

Email: [email protected]

The Trust does not hold a policy as requested, however the process for the Trust is the referring hospital would ring the fracture clinic or orthopaedic department and we would provide them with the contact email [email protected]%20

and they would email details. The referral would then be triaged and an appointment will be made, alternatively patients can be referred by their GP. This is the same for both adult and paediatric patients.

There are two ways that a patient who meets the criteria in the above examples could be referred to the Trust:

Firstly, the referring hospital can contact the on call consultant, or secretary of the patient’s local hospital and the necessary paperwork such as imaging and patient letters will be transferred over for review by an on call consultant to decide an appropriate clinic to book into.

The second way would be for the patient’s GP to send the patient details onward on receipt, of the ED discharge letter to their local hospital to arrange an appointment.

This process is the same for adults and paediatrics.

Out of hours call the hospital switchboard (01325 380100) and ask to speak to the on call orthopaedic surgeon.

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Any patient requiring inpatient transfer should be discussed with the orthopaedic on call registrar prior to proposed transfer.

Patients who require outpatient follow-up should be referred to the senior orthopaedic secretary or fracture clinic for assignment to the most appropriate consultant’s care. All relevant clinical notes and images should be forwarded to the accepting team at the Trust prior to the patient’s arrival.

The patient is seen in another hospital. The Registrar from that hospital would contact the On-Call Registrar at the Lister Hospital and would refer the patient for treatment for follow up and would send images via PACs system for the Lister Hospital to review. The On-Call Registrar at the Lister Hospital would add the information to the electronic system for treatment or would email the virtual fracture clinic for a follow up appointment.

A patient attends the GP with a discharge letter from another hospital. The GP would refer to virtual fracture clinic via email and would request images to be sent via PACs system. The patient would be discussed in the virtual fracture clinic the next ay and contacted with a plan.

If a patient had an injury and was unsure of the process, they would attend the emergency department and be added to the system from admission.

There are 3 routes for patients to be seen and FU following orthopaedic injury being sustained elsewhere and having received the appropriate initial management at the hospital where they first attended.

• Patient is being referred directly to orthopaedics by hospital that they have attended, following this they would be offered appointment in the fracture clinic.
• Patient attends GP who then refers him to orthopaedics.
• Patient presents in Emergency Department.

Patients sustaining trauma out of area when they live within our catchment area are normally referred to their closest fracture clinic by the referring hospital via the relevant fracture clinic generic email address. This instruction is normally given to the referring hospital on receipt of a phone call to fracture clinic. We ask for the written referral and any diagnostics to be transferred to us as soon as possible and we contact the patient and make a follow up appointment from that point onwards.

The email address are:

• William Harvey Hospital Ashford – [email protected]
• Kent and Canterbury Hospital – [email protected]
• Queen Elizabeth the Queen Mother Hospital Margate – [email protected]

For both adults and children, the referring hospital will send a request either to the GP to ask for follow up to be arranged, or give a letter to the patient to bring to the hospital to arrange the appointment themselves. The patient would need to bring their letter to the clinic with them.

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The route of this referral would be dependent on the information that they are given from the Clinician referring, there are many ways that this occurs:

1. Told to attend their General Practitioner practice for onward referral to East Sussex Healthcare NHS Trust (ESHT) Fracture clinics – we have generic email addresses that the GPs uses.
2. Told to attend their local Emergency Department (ED), during office hours these patients are usually directed to fracture clinic and appointments are made. Outside these hours ED will make the appointments.
3. The referring clinician may send a referral to a specific consultant via the generic email addresses or specific address.
4. The referring clinician may contact the Trauma Coordinators or Trauma Team at ESHT and be advised how to proceed.
5. The referring clinician may advise the patient to attend their local fracture clinic.

All of the above would result in the patient being made a fracture clinic appointment in our fracture clinic service at either Conquest Hospital or Eastbourne District General Hospital.

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Virtual fracture clinic booking form

Virtual fracture clinic patient information

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Once the patient has been treated and discharged by the Emergency Department they have attended nearest to where they were staying, the doctors should provide the patient with a ‘Discharge Summary’ which should include the ‘Follow Up Plan’.

A referral can be made two ways:

1. The Emergency Department (where they were staying) could make a hospital-to-hospital referral to the LOCAL hospital stating the Follow Up Plan and will arrange the necessary outpatient appointment.
2. The patient could take the Discharge Summary to his local GP who will then make a referral to the LOCAL hospital stating the Follow Up Plan and will arrange the necessary outpatient appointment.

Please note that George Eliot Hospital NHS Trust, do not treat Paediatric Orthopaedic patients, hence referrals will go to University Hospitals of Coventry and Warwick.

People who have had an injury elsewhere access our care in different ways:

• See their GP who refers them in through fracture clinic
• Attend ED (at request of referring hospital) and get into system through trauma triage

If a patient has sustained a trauma/fracture injury elsewhere and has started treatment at a different hospital due to the location of where the injury took place, patients can then be followed up at their local hospital.

The patient would be advised to call up the fracture clinic to book into the Trust’s ‘CAS CARD’ clinic. The patient would need to bring with them the referral notes from the hospital that initially treated them and a disc containing any images taken by radiology. On occasions the referring hospital will contact the local hospital on behalf of the patient and arrange an appointment for them. The hospital that treated the patient initially will then either send over the images to the Trust’s radiology team for upload, or send them with the patient.

The Trust also accepts email referrals from GPs (sometimes the patient goes there first or to the hospital where the injury has taken place). If they the Trust will ask them to transfer images through the Image Exchange Portal (IEP) system.ype here

The hospital where the patient is being seen would usually write a letter/ discharge summary and provide the imaging on a disc / arrange image transfer via the PACS system.

The patient is then advised to contact their local hospital fracture clinic, where our admin staff then book them into the next available new patient slot.

Whilst patients should not be encouraged to attend ED to arrange a fracture clinic appointment, upon return to their own catchment area, however, if they do, the ED staff will usually triage, check no issues and book into the next available fracture clinic slot if required’

We accept referrals into fracture clinic through the GP or if patients attend ED with their notes from a different ED an appointment can be made. The patient should attend ED with their notes (and please image link X-rays if possible) or to make a GP appointment and the GP can refer in for an appointment in fracture clinic.

Contact their GP and ask for a referral to Orthopaedics , the patient would usually have the CAS card from their ED attendance

A direct referral would be received from the referring ED direct to Orthopaedics

The pathway for patients diagnosed with a fracture outside of the local area who return to us for care are asked to attend ED with a letter from the hospital where they were initially treated. ED staff then set up an encounter and book the patient into fracture clinic for further management, they are then treated the same as if a patient had initially presented here for care.

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We often receive local patients who have attended elsewhere, who have been through our ED/UCC and we see them in the VFC as a usual referral.

There is also the GP hotline number, so if a patient has been seen out of area and attended their GP for follow up, the GP can refer into us via that number, however one condition is the patient must have had an x-ray or received IEP of images at our trust, otherwise, we cannot accept them into VFC and they must attend ED/UCC for x-ray and referral as usual.

The orthopaedic team would give the patient a form to take to diagnostic imaging which would be linked across the imaging to the new Trust and would then advise the patient to go the Emergency department of their chosen Trust to request a fracture clinic appointment. The GP will also be copied into any correspondence, so they are also aware. This is how we would expect patients to come across to us too, via ED/UTC requesting a fracture appointment.

If the patient required surgery, then the referring Consultant would contact the Consultant at the new Trust to discuss and hand over the patient care and they would then be seen in fracture clinic.

These are the following steps that the referring hospital would need to go through to ensure that an Orthopaedic outpatient follow up appointment was arranged at the patient’s nearest- to-home hospital (JPUH in this case).

1. The patient could be transferred via sending clinical correspondence from the hospital where the patient was being treated (discharge letter accompanied with clinical consultant correspondence detailing reason for the transfer of care to the home hospital). Ideally, this should also be copied to the patient’s GP for clinical information and update and also to any onward care required locally when the patient repatriates

1. This would need to be accompanied by a tertiary referral data set to the receiving (home) Trust for the 18 Week Pathway (Access) team to add on to the PAS administration system in order to add the patient’s referral, if available.The referring consultant should also have a verbal handover of care (over the telephone with the receiving Orthopaedic Consultant) to formally agree repatriation and transfer of care.

The receiving Trust’s Access and Orthopaedic admin teams would then correspond to confirm acceptance of the patient on the outpatient waiting list and ideally finalise correspondence with the referring Trust, indicating when the OPA would be arranged for the patient for assurance.

• The process is the same as (1) for arranging a paediatric orthopaedic outpatient follow-up appointment at the nearest-to-home hospital.

• The only possible addition to this process, would be with respect to the nature of the specific orthopaedic injury (as Paediatric Orthopaedic care at the JPUH is provided by visiting Paediatric Orthopaedic Surgeons from the Norfolk & Norwich University Hospitals NHS Foundation Trust).

In this situation, we would need to ensure that the Visiting NNUH Paediatric Consultant is made aware of the referral and agrees to accept the referral, and the referral would be managed in the same way as above.

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We have 4 avenues in accepting referrals for outpatient follow up for local patients treated out of area. This process is the same whether the referrals are adults or paediatric patients.

• The out of area hospital contacts the orthopaedic department, generally by phone or email, to make an orthopaedic appointment for follow up for the patient. At this point they would also email across a discharge summary highlighting injury and treatment provided. They would also send images i.e. x-rays across to us by a secure link.
• Out of area hospital gives all paperwork to patient and they contact the orthopaedic department to make the follow up appointment with us.
• Out of area hospital contacts the patients GP and asks them to make the referral to the patients local hospital.
• The final method is via an Etrauma database link, this is an online referral to the department. This method tends to be for inpatients that require transfer to us for definitive and further treatment.

Hospitals should direct their referrals to the following email address [email protected]

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In general the process would usually be a referral into us from the attended hospital, either via GP or direct from the ED dept the patient has been seen in. The patient would usually be seen here as a new patient and not a FU as the patient is new to the Trust.

Referrals can be sent to our generic departmental email account – [email protected]. This email account is monitored and actioned daily

We have an adult and paediatric virtual fracture clinic.

If the patient is walking wounded and safe to go home, then they should be discharged home and referred via our VFC pathway which is on our website.

If the patient requires urgent surgery as per MTC protocol it should be fixed locally with the referrer then repatriated via the Oncall consultant MTC or T&O.

The Orthopaedic Department is happy to take over the care of a paediatric or adult patient who has received their initial orthopaedic care at another hospital which is outside of their local area. This hospital would require a referral from the patients treating hospital so that this hospital is made aware of the patient requiring ongoing care and the request for this to be provided at this hospital. A referral would also be required so they are appropriately triaged to the correct service within orthopaedics.

There may be some examples where it is better for a patient to remain at their first treating hospital for example if the patient requires some specialist input which is not provided at Lewisham and Greenwich Trust. The Evelina provide a specialist orthopaedic paediatric spinal service which we do not provide here.

The NHS Constitution identifies that patients have a right to choose a specific hospital site and / or consultant, and therefore patients should be supported in making these choices at the time of referral.

Patients may choose to be referred to services outside of their catchment area, in this instance, North West London, and this may include NHS funded independent sector providers. This is permitted through the NHS constitution but, in order that equity of access is maintained, it is important that any referrals made meet the most stringent of the following:

• Any published referral guidelines
• Out of area provider specific referral guidelines

The referring practitioner must ensure that this compliance is documented in the referral and in the patients GP (General Practitioner) record.  In addition the GP will discuss suitable referral locations during the referral consultation.

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A patient from our locality who had suffered an orthopaedic injury which was initially treated elsewhere can be referred back into our follow up system by a number of different routes. This can include:

• Direct referral from treating unit to On call Orthopaedic Middle Grade, via switchboard;
• Asking patient to contact their GP on their return home to arrange follow up via fracture clinic;
• Patient being advised to attend ED on their return home to ‘book in’ to the fracture clinic.

The discharging hospital will need to ask the patients GP to refer by email to our virtual fracture clinic. They will be reviewed virtually and booked in with the most appropriate orthopaedic surgeon with us at Medway.

Mid Cheshire Hospitals NHS Foundation Trust does not have a policy regarding the above. However, the referring hospital could refer the patient to the Fracture Clinic via email or letter with appropriate clinical information and any images attached.

The patient could also attend their GP for a referral to the Fracture Clinic.

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Adult patient 

Depending on the clinical urgency:

• Urgent-ED attendance  followed by (Virtual Fracture Clinic (VFC)
• GP acute referral via email ([email protected])
• Advice and consultation
• Urgent referral through NHS e-Referral Service (ERS)

Paediatric patient, aged 16 and under:

• Urgent-ED attendance  followed by VFC or
• Urgent referral through ERS.
• Hospitals would normally do a consultant to consultant referral, if the referral is urgent the C2C referral could be sent to this address ([email protected]) If the referral is a trauma patient they would normally contact the on-call team or trauma co-ordinator through switchboard.

Outpatient care can happen in one of two ways. The first is to provide the patient with a letter to take to the local A+E to book into the fracture clinic. The other is to contact the on-call registrar for them to take on the task of booking the patient.

The same process is in place for adult and paediatric patients. A referral with imagingwould usually be sent from the hospital where the patient presented. Email – [email protected]

Failing that, a GP referral can be made or the patient could visit the Emergency Department.

We just need an email referral from the treating ED or the patient’s GP to our fracture clinic email address, that is enough for a referral and it will be triaged by a T&O consultant as to the most appropriate acute clinic.

[email protected].

The referral hospital needs to give as much of information as possible to the patient. This includes a discharge summary with mechanism of injury if any, diagnosis, date of attendance/admission, treatment provided, a follow up plan and an approximate time scale for local review. If they had any surgery, a copy of the operation note is also expected. If they have any investigations such as x rays, this is expected to be transferred on to our local PACS system (If this has not happened, we can still get the PACS images transferred by contacting the referring hospital on the day of patient attendance).

A copy of the discharge summary should also go to the patient’s General Practitioner.

The patient needs to contact their GP with these details. The GP will then refer the patient to the orthopaedic consultant on our Advice and Guidance system. Following this, the on call orthopaedic consultant, having reviewed the case, will organise a timely appointment.

Alternatively, if the patient is unable to get through to their GP, they could ring the Fracture Clinic reception directly, who will book the patient into a trauma clinic. The patient will be asked to bring their paperwork with them.

The process is the same for under 16s, however, it would be the parent / guardian who would have responsibility for the information from the referring hospital and for contacting the GP.

The path for this is:

•      Ask the primary hospital to talk to us and refer (they would know how to do that)
•      Request the GP to refer to the local hospital

Also to remember that the referral hospital should have done the referral to an appropriate local hospital depending on what kind of fractures they were

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Following is the pathway that is followed for such referrals:

• Letter from treating hospital/GP received by the fracture clinic reception/nurse in charge
• Details of patient and injury triaged by consultant in the fracture clinic
• Decision made regarding the urgency of the appointment and appropriate slot booked in clinic
• Clinic informs patient regarding the date and time of appointment
• Patient seen by consultant/middle grade in the clinic and appropriate treatment given

The process would be the same for paediatric patients.

Referral can be sent from either hospital, GP or Patient directly to the [email protected]

If patient has a problem prior to us receiving the referral they should present to the Urgent Treatment centre with the discharge paperwork and a referral to us will be completed by them.

The referring hospital are required to transfer any images at the point of referral, as this may slow down the triaging if images are not available.

Full Trust referral pathway here (not that helpful)

The referring hospital (A&E/consultant/Fracture clinic) would need to give the patient a discharge summary with information regarding the injury and suggested plan. The referrer then needs to contact the fracture clinic via email with a referral ([email protected]).

This should include any X-Rays taken so that they can be seen by the local clinician at the follow up appointment. The fracture clinic will then contact he patient with a time and date. All patients are seen within 72 hours of referral.

If a patient was seen in an out of area hospital, that hospital would need to refer to the trauma and orthopaedic services at the Oldham Hospital with a referral letter. This would then be reviewed by the clinicians and an appointment booked for the patient.

Referral letters should be sent to The Orthopaedic Trauma Department, Royal Oldham Hospital

The hospital where the patient received their treatment would need to make a referral to our service, similar to the way a GP practice would. This is assuming the ongoing care required is covered under our directory of service.

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We would review the management detail with the relevant Consultant and see the patient in clinic or treat within our Trauma and Elective Orthopaedics as appropriate.

Pathway available here

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The referring hospital would email the Trust’s Orthopaedic Department with the patient’s information, the patient is then added to the Virtual Fracture Clinic where an appointment would be given

Either referred onwards to us by the initial hospital or informed to attend our Fracture clinic. Once attended their care is taken over by our team and continued until discharged.

There are several routes into a fracture clinic at this Trust:

• External hospital/MIU can email the Trusts Virtual Fracture Clinic (VFC) – secure NHS mail box and request images to be transferred via PAC’s. This is the preferred way to refer. Email address – [email protected]
• Patient can directly refer themselves to VFC, by email and uploading the assessment documents from initial consultation away from area.  Patient can only be reviewed once assessment documents and x-ray images (if applicable) are available.
• GP can refer the patient to VFC, VFC will request images if applicable.
• Patient attends the Emergency Department with documents from initial consultation. This is the least preferred way.

Referring Hospital contacts the Orthopaedic department Trauma Coordinators. The patient would be booked onto a local fracture clinic to be seen by the orthopaedic team.

Referring Hospital may tell the patient to contact the Fracture clinic directly to book an appointment to be seen. RCHT would ideally prefer the hospital contact the Ortho team to ensure the patient has been booked onto the clinic according to the urgency of the person’s injury to be seen in the clinic.

The Trust fracture clinic would require a referral from the hospital that the patient attended. Email – [email protected]

If the patient calls in asking for an appointment, we would ask if they have any paperwork regarding their injury and ensure the Trust Electronic Patient Records system (EPIC) is up to date with all of their details.

We would also contact the hospital where the patient attended (if applicable), and ask them to scan any paperwork into us via our fracture clinic email address (this email is a secure email and is open every day and cleared daily). On IEP we would request any x-rays from the hospital that the patient attended after injury and they we would be uploaded to the RD&E. Once the patient confidential paperwork is received from another Trust, it would upload to EPIC and the consultant of the day would grade to the appropriate clinic that day.

We would contact the patient via telephone with the appropriate date and time of the appointment. A letter of the appointment is also sent out to all patients unless the appointment is imminent.

The Trust’s policy is the same for adult and paediatric patients. If a patient has been treated out of area and has a copy of their discharge summary the patient can make an appointment themselves either by calling the trust switchboard on 020 3758 2000 and ask to be put through to the Fracture Clinic, who will refer to the admin team, or alternatively by e-mailing

• e: [email protected](Royal Free Hospital)
• e: [email protected] (Barnet Hospital)

If the patient does not have a copy of their discharge summary the patient should attend a trust Emergency Department, or their GP should send a referral to one of the above e-mail addresses

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Please be informed that the Trust has no codified policy. There is only ad hoc practice that depends in part upon the actions undertaken by the original, treating hospital.

The treating hospital in the UK can ask for the images to be sent to the Royal Surrey FT and send a referral letter. The patient will be asked to check in and is reviewed by a clinician who will then either view the images (if sent already through the PACS system) or request the original hospital to send the images by IEP. If the patient arrives with images on CD, these can be uploaded to PACS in hours. If no original images are obtainable, we will repeat the imaging.

The local clinician will then review the images and refer on to the local fracture clinic if necessary.

We require a written copy of the patients’ clinical letters and any Radiology from the referring hospital

This is then triaged by the on-call team

An appointment is booked into the new fracture clinic.

More often than not the patient will present at ED here and then gain access to the fracture clinic. Alternatively, they will be referred in by their GP.

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As a minimum we would expect any Xray’s or scans taken of the injury and also any clinical notes.

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The paediatric patient would go via GP referral to our fracture clinic which runs 10 times a week (am and pm each day) Any imaging would be requested from the emergency department which treated them initially.

Patients would need to attend the local Hospital and present at ED with any paperwork needed. If the patient attends without any paperwork then this will be requested by our patient pathway coordinators. ED will review patient and book them into our Fracture clinic, at this point ED will request X-rays from out of area hospital (via our PACS Team) to enable us to see the X- Ray images, in the Fracture clinic. Patient will be booked an appointment within 72 hours of presenting at ED.

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The hospital would have to give the patient a discharge summary and advise that they organise a local review either by attending the local A&E who will refer for a fracture clinic appointment, or ask their GP to refer them to the local fracture clinic.

It would be useful if the referring department could arrange for imaging to be sent to the local department. This would depend on the compatibility of the imaging processing IT. After receiving the referral, we would organise appropriate review.

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The patient would present at Accident and Emergency Department with a referral letter and Xray records / Xray report from the original hospital. The on call SHO would review the patient in AED if immediate orthopaedic input is required and arrange for further treatment / follow up or if it is just a fracture clinic appointment that is required,  AED can sort this directly.

For paediatric patients, they normally attend paediatric ED at Ormskirk Hospital. If orthopaedic input or advice is required, they are either discussed with the orthopaedic team at SDGH or put on the discussion folder for trauma team to discuss next day and advise. If only fracture clinic follow up is required, then paediatric ED is able to do this.

The referring hospital will need to either write a consultant to consultant (C2C) referral to our trust. The referral will then be registered by our central bookings team and uploaded to the system for triage. Once triaged, the patient will be booked an outpatient appointment.

Alternatively, the referring hospital can discharge the patient back to their GP and ask that the GP refers to the patient’s local hospital and then the same process above would be followed.

The majority of the time the patients GP will send a letter to our Patient Booking Services net account, and they will book the patient into the appropriate fracture clinic or elective clinic from that referral. These referrals are excluded from the paper switch-off as fractures are classed as a rapid access service.

On occasion we may have the external Trusts A&E Department send the information to our Patient Booking Services via the same route as above, however, this rarely happens and referral by the GP is generally the process. Paediatric patients may however be referred to Alder Hey hospital for their follow up, as this is the specialist children’s hospital within our region.

In both scenarios (adult or child) the process we would advise would be for the patient (or their carer) to make contact with their registered GP in our area and provide their GP with the information from the treating hospital so that the GP could then refer directly to our T&O department via our designation trauma nurse team email address which all our local GP practices are aware of and use. Once that referral was received, it would be vetted by our on call team and for most patients they would then receive an appointment to come to one of our fracture clinics.

This could also be done directly in theory, bypassing the GP, however the treating hospital could be anywhere and so they wouldn’t be aware of our TNT email address. Therefore, in order to bypass the GP we would need the treating hospital clinician to contact our T&O on-call team (SHO) via our switchboard to discuss referral. The SHO would then check that our consultant on call was happy to accept the patient and if that were the case then the TNT email address would be provided for them to email over the referral details. Again, this would be picked up by the trauma nurse team who make arrangements for a fracture clinic appointment.

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The Trust would accept a referral from either the Trust who treated the patient or their GP in order to provide treatment going forward. This would need to be submitted to the trauma and orthopaedic team, is the GP is referring it would need to be submitted via e-referral.

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A patient from our locality who had suffered an orthopaedic injury which was initially treated elsewhere can be referred back into our follow up system by a number of different routes. This can include:

• Direct referral from treating unit to On call Orthopaedic Middle Grade, via switchboard;
• Asking patient to contact their GP on their return home to arrange follow up via fracture clinic;
• Patient being advised to attend ED on their return home to ‘book in’ to the fracture clinic.

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Ring New Cross Hospital on 01902 307999 and ask for the on call orthopaedic trauma team.  They would put you through and that team would arrange the necessary you would then need to send the documentation through to that particular consultant who would be named in that conversation.

RWT NHS’s policy as per your enquiry above is:

• We require a written copy of the patients’ clinical letters and any Radiology from the referring hospital
• This is then triaged by the on-call team
• An appointment is booked into the new fracture clinic

A referral needs to be made to the local hospitals Orthopaedic department with any relevant medical records for clinical triage by one of our Consultants. The booking team will then process the request and book the required follow up based on this clinical triage. 

Referral can be made preferably via email but also by post.

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The usual practice would be for the patient to be referred to UCLH and we would take over their care. This would usually be via their GP but in some instances it could be a hospital tohospital transfer depending on the urgency.

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• Referring hospital rings one of the on-call docs or trauma nurse, or the fracture clinic – who will pass it on to the clinic booking department.
• Patient’s own GP gets in touch via letter or phone when the patient returns and asks them how to sort follow up.
• Patient turns up in clinic asking them to arrange follow up.

The best contact number would be the below:

• Royal Derby Hospital Switch Board – 01332 340131
• From here, please be asked to be directed to the Fracture Clinic

In children the referral usually comes in 3 ways:

• GP refers via OPD system GP – General Practitioner OPD – Outpatient Department.
• Parent turns up with child to Children’s Emergency Department and is referred to the fracture clinic.
• Referring hospital sends a referral through to Paediatric fracture clinic with a letter and images transferred (this occurs less often but is usually the preferred method).

Patients for repatriation are referred to the on call orthopaedic team for triage and management plan. All repatriations are treated as a new referral.

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The Emergency Department can refer the patient to us via fax or emailing our booking office. The booking office will book the patient into our virtual facture clinic for triage (this generally occurs within two days).

If our consultant needs images, they will ask the referring centre (other hospital Trust) to send the images to us as we cannot view them. Assuming the patient sustained a fracture; the hospital refers to us via fax or email to the booking team and we see the patient the same as any other referral.

If the child had sustained an injury where they need follow up within the immediate post op period, we would receive verbal communication via the on call team to discuss transfer of care and request written confirmation of the episode from the referring centre, including transfer of any relevant imaging. They would then be booked a fracture clinic follow up (clinic runs Monday – Friday every afternoon). We manage these situations quite regularly, whether it be children from BNSSG (Bristol, North Somerset and South Gloucestershire) travelling to the south west for holidays, sustaining an injury with treatment in Plymouth, Cornwall etc, and coming back to us following treatment, or those children from the south west coming to us as the major trauma centre and referring back to locality for local follow up to avoid the need for further travel

University Hospitals Coventry & Warwickshire NHS Trust have Referral Assessment Services set up on e referrals. The GP would refer in electronically to this service which is monitored daily and the patient would receive an appropriately timed appointment. All documents are attached and images can be transferred electronically for the appointment.

The patient would have to see their GP to be referred in and the original hospital can transfer imaging or we can request them to refer imaging, if required.

If a patient is injured elsewhere, the patient/GP or hospital contacts the PHTC (Professor Harper Trauma Clinic) triage area where arrangements are made for the patient to be reviewed or for the case to be discussed in the virtual clinic.

The phone number for the patient to contact is 0116 258 5430. Pathway available here

Patients can be referred into our services for follow up from another hospital in a number of ways:

• Patient is given a letter from treating hospital and takes this to ED in local hospital who makes them an appointment at the Fracture Clinic
• Patient is given a letter from treating hospital and takes this to their GP, who requests appointment either through the Advice and Guidance system or via the Fracture Clinic Hub. Patient is then seen in the Fracture Clinic

It is difficult to provide specific advice without understanding the injury, however generally the process is included below.

The referring hospital provides discharge information and plan of on-going care to the patient’s GP. The GP can then determine if the patient requires referral to the Fracture Clinic, or whether the patient would need to be referred to the Musculoskeletal service for on-going management.

If the patient remained an inpatient then this would require a Consultant to Consultant referral from the out of area hospital to the local hospital who would then consider repatriation.

The Trust does not have a recorded procedure/process for this circumstance. As patients can access care anywhere, we would expect another Trust to operate a similar arrangement to that described below in our original response for receipt of patients injured out of area.

• Images transferred to the local hospital
• Referral made to local clinic prior to discharge if possible (if not we advise to go to GP or present in local Emergency Department to get a fracture clinic appointment)
• Copy of relevant notes/out-patient notes given to patient or emailed to secure email address of appropriate clinic or secretary.

Both adult and paediatric patients who sustain injuries out of area are referred using the same process. Hospitals generally request patients to attend their GP however they can refer direct.

The process requires the referring GP/hospital to send the referral by email using our secure email via NHS.net. These are reviewed daily, and appointments made for the patient to be followed up in clinic. During the review of the referral a request is made for any imaging to be transferred to the trust, if not already transferred, to ensure as much information is available at the time of the appointment.

If the appointment is required urgently the department will contact the patient or family member to arrange the appointment.

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When a Patient attends another hospital but would like to be followed up locally we rely on the patient explaining this to the attended hospital at the time, then:-

• The attended hospital sends the xrays straight over to WSH AND the discharge notes
• The attended hospital gives the patient the discharge notes before they leave
• The Patient calls us when they get home and we then chase the paperwork from the attended hospital
• The patient gets home calls their GP and they make a referral with all details on to the above email address.
• Secretaries picks up VFC emails, prints them off checks they are for VFC, then check for Xrays – if these have not been sent from Attended hospital we then send a request to the attended hospital
• If the Patient do have the paperwork we ask them to get the paperwork to us and then add to VFC
• If none of the above happens then plaster room arranges to get as much of the information needed.

The Direct VFC email is [email protected]

Telephone Number is our Plaster room 01284713309

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For local residents who have had initial trauma surgery elsewhere, we continue their care at the Whittington (as an outpatient or via inpatient transfer). This is organised via daily consultant led trauma meetings.

If the care is ongoing for the same injury, then the referral from the clinician who saw the patient following their initial injury is sent either electronically or via letter to Orthopaedics at Wirral University Teaching Hospital

Once received the referral is clinically triaged, additional information requested if needed, and the patient booking into the next available face to face appointment if a telephone consultation isn’t appropriate. If it’s a new or associated injury patients will be seen in fracture clinic at APH, following attendance at ED or urgent referral from a GP.

All patients that require an OP appointment at our Trust or to be follow up for recent treatment, would require a referral from either the hospital the patient was treated and seen or a referral from the patients GP. Either way the referral would be triaged and graded by the consultant to establish how urgent the patient needs to be seen etc. Email – [email protected]

The referring clinician would need to contact the fracture clinic at Royal Albert Edward Infirmary for initial triage. Once confirmed that the referral was appropriate for fracture clinic, the referring clinician would be given the fracture clinic nhs.net address and asked to send the relevant paperwork to the nhs.net account. The patient would then be booked to the appropriate clinic.

Occasionally, patients contact fracture clinic directly for the same reason and the same process is followed (assuming the patient has the relevant paperwork from the referring hospital). If they do not have the correct paperwork, they are asked to request this from the referring hospital, so that the referral can be actioned as above.

The same process is followed for paediatric patients

We can confirm that the referring clinician would contact the Fracture Clinic via telephone on 01942 822109 for initial triage.

A patient from our area who sustains an injury requiring follow up whilst out of area can present to ED can request a fracture clinic appt. In theory this could be administered by the ED reception team of the ED that they attended for their initial management.

If they have the correct immobilisation in place and copies of their notes/imaging then this can be booked automatically by the reception staff. They may check this decision with a senior clinician.

If they do not have access to appropriate imaging then they will need to be seen by the ED team and imaging obtained so that their follow up can be booked.

If they suffer a complication of their acute treatment prior to their fracture clinic follow up appt they would attend ED as any other ED attendance for management and then onwards referral as required.

The simplest route to ensure review would be for the ED to email the ED attendance record (including clinical notes) to our virtual fracture clinic email, [email protected]

Ideally, the referring team would also arrange for transfer of the relevant radiographic images onto Yeovil PACS via the usual interhospital transfer mechanism, the IEP (Image Exchange Portal). This would save our VFC team from having to request the images later and ensure that a timely review is possible.

The notes and images would then be reviewed on the next available VFC (weekday mornings with extra interval clinic over Bank Holiday weekends) by the VFC team (T&O consultant, T&O outpatient sister and a member of the admin team)

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