TRAUMA: INTRA-SPECIALITY SPECIALIST REFERRALS

Abstract

Introduction: Complex fractures and singular acute orthopaedic admissions in an individual hospital form only a small proportion of admissions. An average orthopaedic surgeon does not gain and maintain enough experience to provide proficient care. Referral with in the department to a sub-specialist for that anatomical region is forming a norm. We studied the practice in our department to assess how much specialist care we provide.

Materials & Methods: Prospective study over four month’s period with specialist referrals reported by teams and Trauma Fellow. We observed the time spent before making the referrals and that taken by specialists in carrying out management. The spectrum of investigations by various specialist teams was also noted. Number of referrals made to each sub speciality was observed.

Results: Of a total of 836 acute admissions in the department over this four months period, 98 (11.7%) were referred to sub-specialists. Referrals were made on an average of 1.8 days after admission and were seen by the specialist after another 2.1 days. Average time to surgery was 4.7 days after referral. Special Imaging investigations were performed in 84 (86%) patients of whom 31 had been organised before the referral was made. 81 (82%) patients were operated by the specialist teams while rest underwent conservative treatment.

Discussion: With the changing structure and decreasing duration of higher specialist training, expertise in complex trauma is expected to be limited to the anatomical region of surgeons’ interest. Specialist management provides better patient care with improved satisfaction.

Conclusion: In the modern orthopaedic practice with intensive but limited expertise, specialist referrals are the acceptable solution both to the patient and the provider. This should be encouraged. Specialists should provide appropriate investigation and referral protocols.