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Delay to orthopedic consultation for isolated limb injury: cross-sectional survey in a level 1 trauma centre.

OBJECTIVE
To describe referral mechanisms for referral to orthopedic surgery for isolated limb injuries in a public health care system and to identify factors affecting access.


DESIGN
Cross-sectional survey.


SETTING
Orthopedic surgery service in a level 1 trauma centre in Montreal, Que.


PARTICIPANTS
We conducted a prospective study of 166 consecutive adults (mean age 48 years) referred to orthopedic surgery for isolated limb injuries during a 4-month period.


MAIN OUTCOME MEASURES
Self-reported data on the nature of the trauma, the elapsed time between injury and orthopedic consultation, the number and type of previous primary care consultations, sociodemographic characteristics, and the level of satisfaction with care.


RESULTS
Average time between the injury and orthopedic consultation was 89 hours (range 3 to 642), with an average of 68 hours (range 0 to 642) for delay between primary care consultation and orthopedic consultation. A total of 36% of patients with time-sensitive diagnoses had unacceptable delays to orthopedic consultation according to the Quebec Orthopaedic Association guidelines. Lower limb injury, consulting first at another hospital, living far from the trauma centre, patient perception of low severity, and having a soft tissue injury were associated with longer delays.


CONCLUSION
Identifying gaps and risk factors for slower access might help improve referral mechanisms for orthopedic consultation.