A Physiotherapist-Led Paediatric Fracture Clinic was a Safe and Efficient Alternative to Traditional Outpatient Orthopaedic Care: A Preliminary Evaluation

Background: Demand for publicly funded orthopaedic outpatient services is growing rapidly which affects a health service’s ability to provide timely care. The current study describes the implementation and preliminary evaluation of a novel physiotherapist-led paediatric fracture clinic, which was introduced to provide more timely care to children. The study evaluated 1) the length of time patients spent in the outpatient department per appointment, 2) did-not-attend rates and 3) unplanned re-presentations to the clinic for the same problem. Methods: The study was conducted at a large regional hospital in Victoria, Australia. A physiotherapist-led paediatric fracture clinic was introduced in 2013 to provide care to children with acute simple limb fractures. Descriptive data for all patients seen in the clinic between 1st January 2013 and 31st December 2018 were collected prospectively. The performance of the new service was evaluated by comparing it to the pre-existing orthopaedic surgeon-led fracture clinic for the six months prior to the introduction of the new service for 1) the total time patients spent in the outpatient department per appointment and 2) the number of patients that failed to attend an appointment. The pre-existing surgeon-led clinic was also compared to the surgeon-led clinic for the six months following the introduction of the physiotherapist-led clinic. Total time spent in the department per appointment was compared between groups using linear regression, controlling for age, diagnosis and appointment type (new or review). The proportion of patients who did not attend an appointment were compared between groups using the chi square test. The number of unplanned representations to either clinic was assessed between 01/01/2013 and 31/12/2018. Results: Between 2013 and 2018, there were 4337 attendances at the physiotherapist-led clinic. Total time in the department was significantly less (p<.05) for patients seen in the physiotherapist-led clinic when compared to the pre-existing surgeon-led clinic (median difference 82 minutes). Total time in the surgeon-led clinic also reduced following the introduction of the new service (median difference 21 minutes). Did-not-attend rates (10.3%) and unplanned re-presentations (0.6%) were similar (p>.05) between the groups. Conclusions: The physiotherapist-led clinic improved the timeliness of care for paediatric patients without evidence of compromised patient safety. KEYWORDS: Paediatrics, musculoskeletal health, service evaluation, service redesign, workforce reform, fractures, orthopaedics.