Audit of a dedicated scaphoid pathway

Purpose

To evaluate the implementation of a service redesign for patients with suspected scaphoid fractures. A scaphoid fracture is a diagnostic and radiographic challenge for clinicians with heterogeneity of assessment and treatment nationally. We propose an advanced physiotherapy led model that reduces both direct and indirect costs to the patient, trust and NHS that is shown to be safe and effective.

43%
of patients referred to the pathway were discharged on assessment
0.25%
of patients returned to hospital in three months post discharge

Approach

Audit of 400 cases referred to the pathway. Number of attendances, MRI´s ordered, DNA´s, discharges, outcome of further imaging and return rate to the hospital were evaluated for efficacy and safety.

Outcomes

400 patients included

  • 114 MRI performed (29%); 13 scaphoid fractures (3%), 48 "other" fractures (12%), 53 negative MRI (13%)
  • 170 patients discharged on assessment (43%)
  • 112 Did not attend (28%)
  • 3 returns to the hospital in three months post discharge (0.25%)

Cost and savings

The pathway set up reduces radiology costs and exposure, time immobilized for the patient and reduced clinic attendances with associated cost reduction. Furthermore the pathway has been shown to be safe by auditing re attendance rates through a dedicated hotline for such patients who had not recovered.

Implications

We show a safe and cost effective way to reduce the burden of a suspected scaphoid fracture to the patient, trust and NHS. This service has been designed and implemented by advanced practitioner physiotherapists within a large trauma hospital with great success to date.

Top three learning points

  1. A skilled assessment by a well-trained practitioner is needed to see patients with a suspected scaphoid fracture as they are a diagnostic challenge.
  2. Timely assessment can reduce direct and indirect costs such as clinic appointments, imaging, length of time in cast and time off work.
  3. This audit will lead to further work looking at diagnostic accuracy of clinical tests and the validity of clinical prediction rules.

Fund acknowledgements

This work was not funded.

Additional notes

Presented at Physiotherapy UK 2018. 

This work won best poster presentation at BSSH Autumn meeting 2017