530 Repatriation of Care for Ambulatory Orthopaedic Trauma Patients Audit

Aim The safe repatriation of care for non-local ambulatory orthopaedic trauma patients to their local trust is vital. Poor documentation and communication between trusts leads to delayed treatment and poor outcomes. Thorough documentation is required to prove that a satisfactory referral has been made. This audit, with two-closed loop cycles, aimed to improve the repatriation process. Method At a London MTC, electronic patient records were reviewed over a one-month period, examining 6 areas to assess referral quality to local trusts (initial data collection, n=17). Interventions were implemented, followed by a re-audit over a further one-month period (n=25), which was then repeated (n=18) after secondary interventions. Initial interventions consisted of the development of new departmental guidelines (referral pathway, electronic repatriation letter template, patient information e-leaflet). Secondary interventions consisted of educational posters and a doctor tutorial. Audit standards: BOAST Fracture Clinic Services and trust recommendations. Results Documentation of: Named local trust in clerking, 65% to 96% to 89%; Evidence of phone referral, 94% to 96% to 100%; SHO/registrar’s name taking referral, 24% to 88% to 94%; Local trust Consultant on-call’s name, 6% to 48% to 83%; Repatriation letter sent to local trust, 0%* to 92% to 94%. Uploading of the repatriation letter to electronic record, 0%* to 40% to 89% (*letter only introduced during initial interventions). Conclusions Improvements have been made in all areas, increasing the quality and accountability in referrals to local trusts. We recommend the introduction of formal referral pathways for non-local ambulatory orthopaedic trauma patients to prevent miscommunication and treatment delays.