Nenagh Patients Benefit from Trauma Assessment Clinic

The TAC is located at University Hospital Limerick and delivered by the Department of Trauma and Orthopaedic Surgery. This service allows for the remote assessment and management of patients with specific injuries, who until now would have been referred to the Fracture Clinic at University Hospital Limerick.

 
TACs represent a new care pathway for patients with specific injuries and are recommended under the Trauma and Orthopaedic National Clinical Programme as a means of streamlining the patient journey after an injury without in any way compromising care.
 
A pilot TAC project commenced at Nenagh Injury Unit in early September 2017 and to date over 40 patients have come through this pathway.
 
TACs are an innovative service that allows patients to be reviewed remotely by the orthopaedic team following attendance at an Emergency Department or an Injury Unit. It also allows for appropriate triaging of patients to ensure that their injury is managed by the most appropriate person at the most appropriate time.
 
Audrey Butler, Advanced Nurse Practitioner, Orthopaedics, UL Hospitals Group, explained: “It is effectively a virtual fracture clinic where patients attend the Injury Unit in Nenagh with a specific type of fracture. Whereas historically they would have been referred to the Fracture Clinic in UHL 10-14 days after initial treatment at their Injury Unit or ED, they can now be referred to the TAC.
 
“We can review patients' x-rays and documentation remotely and we can have a telephone consult with the patient within a week. For patients and family members who may have had to drive them if they have had a fracture, it means less travel and less time off work.
 
“In Nenagh, we have picked three specific types of fracture that can be referred to the TAC  - initially the clavicle, the fifth metatarsal and fifth metacarpal. We review their x-rays remotely and their documentation from Nenagh and we have a telephone consultation with the patient. Patients with these injuries are no longer brought to the Fracture Clinic in UHL as a matter of routine,” Ms Butler said.

"Patients in the past would have come in and waited for a long time for what often could have been a very short consultation and patients and clinicians alike would question the benefit of that. So much can be done safely over the phone and the patients in Tipperary have responded quite positively to it. They are quite happy not to come in to UHL and they will contact the clinic directly if they have any problems. It has been hugely beneficial and we are already looking forward to rolling it out in Ennis in 2018.”

Dr Damien Ryan, Consultant in Emergency Medicine, UL Hospitals Group and Nenagh Injury Unit, commented: “The aim of this initiative is to increase patient convenience by providing optimal care without the need to attend a busy fracture clinic for a selected group of patients. So far the feedback has been positive and it is planned to expand this facility to other Injury Units in the region with the ultimate aim of also expanding inclusion criteria.”
 
Mr Brian Lenehan, Consultant Orthopaedic Surgeon, said: “The TAC is a redesign of the traditional fracture care pathway. It is an enhanced pathway for patients with simple stable injuries, which adds convenience and is a smarter way of working. The TAC frees up outpatient sessions and allows more new planned orthopaedic patients to be seen.”
 
Dr Damien Ryan, Consultant Emergency Medicine; Brian Lenehan, Consultant Orthopaedic Surgeon/Regional Lead, Trauma and Orthopaedic Clinical Programme; Audrey Butler, Orthopaedic RANP; Tricia McKeown; Nenagh Injury Unit RANP; Siobhan Stapleton CNM1 and Dr Nicholas Okoh, Nenagh IU.