RESOURCE UTILISATION AND ITS OUTCOME FOR A PAEDIATRIC ORTHOPAEDIC REFERRAL IN A DISTRICT GENERAL HOSPITAL

Abstract

We conducted a retrospective analysis of all elective Paediatric Orthopaedics referrals during the period 1998–1999 made by general practitioners to one of the two Paediatric Orthopaedic consultants in a moderate sized district general hospital serving a population of approximately 300, 000 with a delivery rate of approximately 3000 live births per year. This study was taken with a view to assess the spectrum of elective Paediatric Orthopaedic referral quality of work generated and to find out the final outcome and hence try to improve resource utilisation. We found out that majority of cases (85%) needed simple assurances or supportive measures, a task that can be easily shared by a trained clinical assistant along with the consultant and routine clinical cases are not adequately covered in Paediatric Orthopaedics courses for trainees.

During 1999, a total of 120 new elective Paediatric Orthopaedic referrals from GPs were seen in 600 bedded district general hospital by one of the Paediatric Orthopaedics consultants out of the 2 in the hospital. Case notes were analysed for age of patient, sex, joint affected, reason for referral, diagnosis made and the outcome following consultation. The outcome was measured in the form of whether the patient had an operation, was referred to Physiotherapy, orthotics, kept under observation (include masterly inactivity), referred to other subspecialty or reassured and discharged. Mean age of presentation was 7. 8 years and there was near equal presentation of boys and girls. Maximum cases were referred for knee problems 32 (26. 67%), hip 28 (23. 33%), foot 18 (15%), general 18(15%).

1. Majority of patients referred need simple assurance to parents and majority of patients seen in Clinics need no operation (85%), indicating that Orthopaedic Surgeons need to spend more time on reassuring parents than on operation, a task that can be easily shared by a trained Clinical Assistant.

2. In majority of Paediatric Orthopaedic training courses, main emphasis is on complex conditions like Perthes’ disease. CDH or slipped capital epiphysis whereas these conditions constitute a minor part of clinical situations. Other common conditions like Inteoing gait, anterior Knee pain, Osteochondritis, flatfeet and other common problems including the normal variants should also be included in the courses so trainees can deal after these clinical problem in a better way in Outpatients.