Abstract
Aim
The ability of advanced practice allied health-led clinics to comprehensively manage acute upper limb trauma has limited evaluation. This study aimed to evaluate the safety, requirement for specialist escalation, patient satisfaction, and patient outcomes of an allied health-led upper limb fracture clinic.
Methods
Eligible outpatients referred to Orthopaedics with acute upper limb fractures were diverted to and managed by the allied health led Advanced Practice Hand Clinic (APHC) between August 2020 and August 2022. Patients were excluded if they did not complete treatment, were referred with chronic conditions, or simple fractures not requiring specialist care. Demographic, diagnostic, service delivery, patient satisfaction and clinical outcome data were collected as part of usual care. Descriptive statistics were used to analyse the data.
Results
Three hundred and twelve patients were eligible, aged median (IQR) 23 (13–47) years, 38% female, and 28% were clinical scaphoid fractures. Wait time for care was 7 (4–11) days. No adverse events were noted. Most (n = 289, 93%) patients completed APHC treatment, with most (88%, 254/289) not requiring orthopaedic consultation. Few (7%, 23/312) patients were returned for orthopaedic management. QuickDASH scores were significantly improved at discharge (4.6 (0–9.1)) compared to initial appointment (48.9 (31.8–57.3), p < 0.001, n = 72). Most patients (98%–100%) were satisfied with wait times, seeing a hand therapist, and with their treatment received.
Conclusion
The APHC safely managed patients with acute upper limb trauma in lieu of Fracture Clinic, reduced reliance on Orthopaedic services, provided good functional outcomes and achieved high levels of patient satisfaction.
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