Introduction
We’ve all been there…
You’ve just seen a patient in the Emergency Department who is going to need Fracture Clinic/Orthopaedic follow up, but they don’t live in your catchment area. They were unlucky enough to sustain an injury whilst on holiday/working away from home. You’ve completed the initial management, a manipulation, a back slab, whatever was needed, but they are keen to go home and fit to be discharged. Usually their follow up is easy – you just ask your receptionist to book them in to your fracture clinic. But how do you organise this at a completely different hospital?
I’m guessing we’ve all tried different approaches. Rung the oncall orthopaedic doctor at their local hospital perhaps, who’s taken the details, but there is never any guarantee that any particular strategy will be successful.
The patient (and their family) has already had their holiday ruined and you just want to ensure the patient’s care is continued in the easiest way possible where they live. The last thing you want to do is to burden already stretched Emergency Departments and General Practice by just telling the patient to “turn up at your ED or GP and they will sort out your follow up”.
Methods
We sent a freedom of information request to every Trust in England asking them how they would suggest a patient was referred to their orthopaedic department for follow up.
The first request…
‘An adult patient (who usually lives in your catchment area) sustains an injury, whilst out of area, that requires Orthopaedic follow up as an outpatient. They have attended the Emergency Department nearest to where they are staying and received initial management and are now able to be discharged for out patient follow up. They would like to have this managed at their local hospital (your NHS Trust)
What mechanism would the referral hospital need to go through to ensure this follow up and timely review occurs. Please include as much detail as possible, imagining that you are the clinician at the referring hospital.’
After receiving some of the initial replies it became obvious that the request had been somewhat confusing and so a clarification was sent…
“What is your hospital’s policy for patients (adult and paediatric) who live in your area who need ongoing care and/or follow up having sustained an orthopaedic injury elsewhere and having received the appropriate initial management at the hospital where they first attended.”
A further email was sent after replies were received to request further detail if appropriate, for example if the response said to ’email the relevant department’ the email address was requested.
Freedom of Information Requests
A little detail about how you can make a freedom of information (FOI) request. In the UK you have the right to see recorded information that is held by public bodies, including the NHS.
To be valid under the Act, the request must:
- be in writing. This could be a letter or email. Requests can also be made via the web, or even on social networking sites such as Facebook or Twitter if your public authority uses these;
- include the requester’s real name.
- include an address for correspondence. This need not be the person’s residential or work address – it can be any address at which you can write to them, including a postal address or email address;
- describe the information requested. Any genuine attempt to describe the information will be enough to trigger the Act, even if the description is unclear, or you think it is too broad or unreasonable in some way. The Act covers information not documents, so a requester does not have to ask for a specific document (although they may do so). They can, for example, ask about a specific topic and expect you to gather the relevant information to answer their enquiry.
After a FOI request the public body is obligated under the Act to respond to requests promptly, with a time limit acting as the longest time you can take. Under the Act, most public authorities may take up to 20 working days to respond, counting the first working day after the request is received as the first day. For schools, the standard time limit is 20 school days, or 60 working days if this is shorter.
Results
Responses were received from 90 of the 135 trusts who were contacted (a response rate of 66%).
Several responses gave multiple ways in which this could be organised, hence why the total is greater than 100%. In some cases it simply wasn’t possible to work out what was being suggested, or a non relevant information was sent.
- Contact GP = 39 responses (29%)
- Attend local Emergency Department = 23 (17%)
- Write to the Trust Orthopaedic Department = 11 (8%)
- Call the on call orthopaedic doctor = 14 (16%)
- A direct referral to fracture clinic = 24 (27%)
- Response not clear = 12 (9%)
Conclusion
In this most simple of patient pathways, many hospitals are still suggesting that a patient needs to attend their GP or local Emergency Department, when the initial management has already been completed. Although it is hard to quantify the number of extra attendances this creates, it is surely an unnecessary burden and all Trusts should be mandated to supply a one stop pathway for referral.
We hope that this Directory will aid clinicians to navigate the different systems currently used and streamline patient care untila a national system can be established
The Directory
The completed Directory can be found here. Please bookmark this on your department’s computers if possible. If your Trust’s information is missing, or even incorrect, please do get in touch and we will correct it. If you work in other areas of the UK and would like to include your details then please do send this.
We would also love to hear if this project has made life even a little easier for you in your Emergency Department.
All best,
Iain
Well done Iain et al… top work. Lee