ISRRT_COVID-19_book
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Rationale<br />
Historically patients with fractures have been returned to the ED with their images and an<br />
immediate report for review by the referring clinician. Unstable fractures may either be<br />
manipulated in the ED or referred directly to orthopaedics for ongoing management.<br />
However, most non-complex fractures require immobilisation and follow up in a fracture<br />
clinic. This latter pathway scenario requires multiple patient hand-offs and repeat hospital<br />
visit before their definitive treatment is initiated. Utilising the orthopaedic staff, who were<br />
not performing elective surgery, 7-day fracture clinics were implemented. This was seen as a<br />
way of reducing the pressure on the ED staff and the number of patients waiting, as well as<br />
the need for patients to return for changes in their treatment. Using this change a new<br />
pathway was designed with the radiographers playing the pivotal role. It is suggested that<br />
without radiographer led discharge pathways, the patient can spend up to 50% of their time<br />
in ED waiting for a decision to be made by the referring clinician after an image has been<br />
taken. Thus development of RLD pathways can significantly reduce patient waits and<br />
streamline discharge processes.<br />
Objectives of the pathway<br />
• To continue to utilise the immediate (hot) reporting service<br />
• To reduce the number of patients returning to the Emergency Department (social<br />
distancing)<br />
• To utilise Radiographer Led Discharge (RLD) for all patients with normal findings on<br />
imaging<br />
• To direct adult patients with a new fracture directly to the fracture clinic<br />
• To utilise orthopaedic staffing to efficiently in the treatment pathway of ED patients<br />
Development of the pathway<br />
The pathway (Figure 1) was developed to stream any adult patient with a fracture directly to<br />
the fracture clinic. The advanced (or consultant) radiographer practitioner immediately<br />
reported the examination and made a decision on pathway route. The RLD pathway has been<br />
in place at the hospital for over 15 years and has become embedded in the service alongside<br />
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