REVIEW OF MINOR AND INTERMEDIATE PROCEDURES IN FRACTURE CLINIC – IMPLICATIONS FOR RESOURCE MANAGEMENT & STAFF TRAINING.

Abstract

Introduction: Many minor procedures are performed daily in fracture clinic and often carried out under intravenous sedation and analgesia. These occur between 9 am and 8 pm.

Methods: All minor and intermediate cases logged in the theatre register at the fracture clinic were reviewed from February 2007 to February 2008. The following items were recorded: month, age of patient, diagnosis, procedure, grade of doctor or nurse performing the procedure and the method of anaesthesia and the time of day the procedure was carried out. Specifically the use of intravenous sedation, intravenous morphine, use of Entonox, and local or regional anaesthetic techniques were recorded. Records were classified by the time of day the procedure occurred – any procedure starting at or after 1730 hours was regarded as an ‘out-of-hours’ procedure.

Results: The age range of patients undergoing procedures ranged from 13 to 100 years, with a mean age of 49 years. 576 procedures were performed, 529 by SHOs, 35 by registrars, 4 by consultants and 8 by nursing staff. The commonest procedure was distal radius manipulation under anaesthesia (MUA) with 227 cases, followed by ankles with 175 cases. Intravenous sedation was used in 473 cases with 95 of these occurring ‘out-of-hours’. Entonox was used in 33 cases. A regional or local anaesthetic technique was used in 38 cases. No anaesthetic or analgesia was required in 10 cases.

Discussion: The ability to perform minor and intermediate procedures is dependent on being to provide safe and appropriate anaesthesia. If the current procedures could not be performed in fracture clinic this would put significant pressures on operating theatre time and would have inherent cost implications. However, in order to provide safe and appropriate anaesthesia for these procedures adequate and contempory staff training is required, especially when intravenous sedation is utilised.