RED AND AMBER FLAG GUIDANCE ORTHOPAEDIC CONDITIONS

Transcription

1 RED AND AMBER FLAG GUIDANCE ORTHOPAEDIC CONDITIONS Distribution list: Clinical Commissioning Groups / All Worcestershire GP practices; Musculoskeletal Integrated Clinical and Assessment Services; Commissioning Managers for distribution to all commissioned NHS Providers; A copy of this policy is also available on the Worcestershire PCT website at the following address: es/commissioning.asp Version: 1.0 Final Version Ratified by: Clinical Senate Orthopaedic Project Group attended by CCG Clinical Representatives Date ratified: March 2012 Name of originator/author: Mr K O Dwyer, Clinical Director, Worcestershire Acute Hospitals Chris Emerson, Orthopaedic Lead, NHSW Date issued for publication: March 2012 Review date: March 2013 Expiry date: March 2015 Target audience: Secondary Care including Independent Sector providers, Primary Care Clinicians and ICAT Service Providers CONTRIBUTION LIST Key individuals involved in developing the document Name Designation Organisation Mr Kevin O Dwyer Orthopaedic Clinical Director Worcestershire Acute Hospitals NHS Trust Ms Chris Emerson Deputy Director - Delivery NHS Worcestershire Mr Melwyn Pereira Orthopaedic Clinical Director Worcestershire Acute Hospitals NHS Trust Dr Rupen Kulkarni Orthopaedic Lead Redditch and Bromsgrove CCG Dr Anthony Kelly Commissioning Lead South Worcestershire CCG

2 ORTHOPAEDIC CONDITIONS RED FLAGS see immediately AMBER FLAGS 2 4 weeks maximum Patients with conditions generally considered to be in the amber category for referral are expected to be seen within 2-4 weeks maximum. In those rare exceptional cases where a more urgent referral is considered necessary it should be discussed with the relevant consultant and an individual management plan agreed. The following conditions (or significant suspicion thereof) should be referred immediately to the local A&E Department: Fractures, Dislocations, Septic arthritis, Head injuries, Spinal injuries Any injury with compromised neurovascular function distally Suspected compartment syndrome or septic arthritis should be referred directly to the on call trauma and orthopaedic SHO. Patients should be sent to the A&E department to be seen by a member of the on call orthopaedic team. Patients with symptoms & signs suggestive of spinal cord compression or cauda equine syndrome with a history of possible metastases or cancer should be referred to the on call medical team for consideration of urgent oncology opinion and plan X-ray spine. The conditions identified in the table below should not be referred to the Integrated Clinical Assessment and Treatment (ICAT) service. Referrals for conditions not listed below should be directed to the patients choice of secondary care provider via the ICATs Service. Providers shall only accept direct referrals in accordance with the conditions listed. This is not an exhaustive list of orthopaedic conditions. It is acknowledged that there may some conditions where the referring clinician will determine that the case should not be referred to the ICAT service; however such cases are likely to be small in number. Worcestershire Royal Hospital Consultants Mr Aslam (01905) Hip & knee surgery including soft tissue problems Mr Docker (01905) Hip and knee surgery including revision surgery Mr O Dwyer (01905) Hip and revision hip surgery Mr Pearse (01905) Knee surgery/revision arthroplasty/soft tissue knee Mr Ratcliffe (01905) Hand surgery Mr Robinson (01905) Knee and shoulder surgery Mr Sadiq (01905) Complex trauma and lower limb arthroplasty Mr Trevett (01905) Foot and ankle surgery As a last resort, If above consultants cannot be contacted fax details to trauma Clinic Alexandra Hospital Consultants Mr Arafa Mr Bell Hand surgery Knee surgery, Lower limb arthroplasty including revision arthroplasty Red And Amber s V1.5 - Final Version - March 2012 Page 2 of 6

3 Mr Knebel Mr Luscombe Mr Mahon Ms Moon Mr Pereira Mr Price Mr Selvey Mr Sforza Mr Mathur Hip & Knee arthroplasty including revision arthroplasty Hip & Knee arthroplasty including revision arthroplasty Hand surgery Hand surgery Foot & ankle surgery Knee surgery Shoulder surgery Shoulder surgery Knee & Shoulder surgery Appointments for Orthopaedic Consultants are made through Emma Kilgallen. Contact details are: Emma Kilgallen Trauma & Orthopaedics. Ext: 47983, External: Fax: Rapid Access Diabetic Foot Clinic (Tuesday Alexandra Hospital fax ) Red And Amber s V1.5 - Final Version - March 2012 Page 3 of 6

4 REFERRAL PATHWAY RED AND AMBER FLAGS Anatomical site Conditions Relevant signs & symptoms Red Head Head injuries Following head injury, period of loss of consciousness, Refer A&E disorientation, confusional state, vomiting, blurring of vision. Amber Neck Back Prolapsed cervical disc with cord or nerve root compression Cauda Equina Syndrome Prolapsed lumbar disc or nerve root compression Stiff or painful neck with pain and/or paraesthesia/ weakness in upper limb grade 3 or below signs of myelopathy e.g. bilateral pins and needles in feet/gait disturbance. Saddle anaesthesia, impaired sensation in perianal area. Recent onset of bladder or faecal dysfunction (e.g. urine retention, f, or overflow incontinence) loss of anal tone on PR Disturbance of gait (apart from antalgic) Unilateral/ Bilateral leg pain radiating to foot/toes with major motor loss grade 3 or below Numbness/paraesthesia in same distribution as motor loss localised to one or more nerve roots Refer to either ROH (South Worcestershire and Kidderminster patients) or UHCW (Redditch and Bromsgrove patients) Refer to either ROH (South Worcestershire and Kidderminster patients) or UHCW (Redditch and Bromsgrove patients). Referral pathway above Suspected infection/malignancy New back pain with patient over Red And Amber s V1.5 - Final Version - March 2012 Page 4 of 6

5 Anatomical site Shoulder Conditions Relevant signs & symptoms Red 50 years, or age under 20 years Referral pathway above where clinical factors raise suspicion Systemic (constitutional) symptoms, e.g. fever, chills, unexplained weight loss, referral to secondary care specialist as appropriate. Acute dislocations Loss of shoulder contour Amber Suspected acute tear of Rotator cuff Possible fractured neck of humerus Acute calcific tendonitis (rare) Loss of function Pain and loss of function following fall Very severe shoulder pain refer to shoulder refer to shoulder Acute frozen shoulder stiff and painful loss of external rotation refer to shoulder Elbow Acute trauma Possible fracture or dislocation and/or neuro-deficit i.e. numbness / weakness Hand Boutonniere deformity. Acute Loss of active ext PIPJ, possible hyperextension at DIPJ with swelling PIPJ. refer to Hand Mallet finger Acute flexion deformity DIPJ dt injury refer to hand Pelvis Possible Pubic Rami fracture Painful groin in elderly patient Red And Amber s V1.5 - Final Version - March 2012 Page 5 of 6

6 Anatomical site Conditions Relevant signs & symptoms Red Hip Possible hip fracture Inability to weight-bear after injury/fall especially in the older patient Amber Possible impending pathological hip fracture Severe pain on weight-bearing of recent onset in the older patient, history of malignancy Knee Suspected infection Rapidly progressive symptoms. Acute meniscal tears with significant knee trauma refer to knee Acute traumatic knee injuries (eg locked knee and dislocated patellae Foot and Ankle Diabetic Ulcers and infections, consider vascular referral Tibialis posterior tendon tears or ruptures Recent onset of flat foot refer to foot Collapsing mid/hind foot -? Charcot joints refer to foot Lisfranc fracture dislocation General Compartment syndrome Extremely severe pain in limb following trauma Notes: Royal Orthopaedic Hospital NHSF Trust (ROH) University Hospitals Coventry and Warwickshire NHSF Trust (UHCW), Coventry Red And Amber s V1.5 - Final Version - March 2012 Page 6 of 6