The pathways for patient referral for specialist musculoskeletal care is fragmented and poorly integrated with other healthcare services. These systems lead to delays in diagnosis, treatment, access to specialist care, and increased healthcare costs. A rural tertiary sport medicine clinic initiated a self-referral Acute Injury Clinic (AIC) to address these issues. The primary purpose was to determine the utilization and access of the AIC. The secondary purpose was to determine the type and incidence of injuries, and the time to tertiary or definitive care. The AIC model utilised a team approach by a physiotherapist and sport medicine physician to assess and diagnose acute injuries that occurred within 10 days. Orthopaedic surgery consultations were completed on the same day or via internal referral processes when indicated. Electronic medical records were reviewed for all AIC assessments completed between December 2022 and October 2024. Demographic data (age, sex) and confirmation of acute injury within the last 10 days were recorded to determine utilization and access. To determine type and incidence of injury and time to tertiary and definitive care, the injury site, diagnosis, activity at the time of injury, time from injury to AIC assessment, and time from AIC assessment to orthopaedic consult and surgery were recorded. Overall, 945 patients were assessed at AIC. Five hundred and one (53.0%) identified as male and 444 (47.0%) identified as female. Patients ranged in age from 7 to 97, with a mean age of 37.7 (SD=17.9). Preliminary analysis of the March – October 2023 (n=262) consultations indicated that 222 (84.7%) injuries were acute. The mean time from injury to AIC assessment was 9.6 days (SD=9.2). Two hundred and thirty-one patients (88.2%) received a definitive diagnosis, with 31 (11.8%) requiring further investigation. The most common activity at the time of injury was a snow sport (skiing/snowboarding) (n=76, 29.0%), followed by slips and falls (n=19, 7.3%), biking (n=17, 6.5%), hiking (n=15, 5.7%), soccer (n=13, 5.0%), and running (n=12, 4.6%). The most common site of injury was the knee (n=147, 56.1%), followed by the shoulder (n=50,19.1%), ankle (n=22, 8.4%), Achilles (n=7, 2.7%), wrist (n=5, 1.9%) and elbow (n=5, 1.9%). Further analysing the 147 knee injuries, the most common diagnosis was anterior cruciate ligament injury (n=55, 37.4%). Thirty-four (61.8%) of these injuries required surgery with a mean time of 98.9 days (range=0–398) and 218 days (range=20–575) from AIC assessment to consent for ACL surgery, and to surgery respectively. Further analysis of the initial 2-years of AIC consultations will be conducted, including comparing AIC and usual care for access and care costs for injuries and surgeries. Preliminary results indicate a successful implementation of a self-referral acute injury clinic, with 88% of consultations resulting in a diagnosis within 10 days of injury. Less than 12% of AIC patients required further investigations. Time to orthopaedic surgery consultation and surgery was reduced compared with provincial care reporting.
FRITZ et al. (Wed,) studied this question.