Title : Analysis of the accuracy and operative relevance of hand trauma referrals in plastic surgery
Abstract:
Introduction:This audit aims is to critically access the accuracy and appropriateness of referrals to the Hand Trauma Clinic. Inappropriate trauma clinic referrals can lead to overloading of the clinic and reduction in specialist service availability and delay in service provision for patients requiring plastic surgery operative intervention. Correctness of initial assessment, implementation of clear trauma referral guidelines as well as supporting peripheral referral units in conservative management are ways of increasing efficiency and reducing the burden on the Hand trauma Service. Method: An initial audit of Plastic Surgery Hand Trauma referrals over a three month period (October 2018 to January 2019), which suggested that referrals were mostly diagnostically accurate, however, only 51.7% required specialist intervention. Consultant-lead hand trauma clinic guidelines were established in October 2019. This was circulated within the department and communicated within the Hospital Trust. 12 months later we closed the audit loop. We aimed to review both appropriateness and referral accuracy by comparing the referring practitioner’s assessment to final diagnosis and the subsequent need for further plastic surgery operative intervention. Results: Results Following introduction of guidelines the results demonstrated a significant improvement i the appropriateness of referrals requiring specialist operative intervention; ascertaining that more is done by referral units to manage patient not requiring plastic surgery intervention. Furthermore, there was no significant change in diagnostic accuracy of referrals. Conclusion: It is evident that although primary assessment by referring units are mostly diagnostically sound, new guidelines can help decrease the burden on the Hand Trauma clinic by not only facilitating diagnostic accuracy but guiding appropriateness of referrals as measured by the proportion of patients requiring operative intervention.
