{
  "abstract": "Aims and Objectives Scaphoid fractures are diagnostically challenging, with 15% radiographically occult at presentation. Traditionally, patients diagnosed with a clinical scaphoid fracture at Queen Elizabeth University Hospital Emergency Department (QEUH ED) were immobilised in a wrist splint and reviewed in a consultant-led EM clinic at 14 days. Patients were subsequently discharged, followed up with an MRI scan or referred to orthopaedics.An initial audit in 2023 revealed high non-attendance rates for clinic and MRI appointments, significant resource utilisation, with most patients ultimately discharged without intervention.This patient-centred service improvement project aimed to evaluate a patient-initiated ‘opt-in’ follow-up pathway introduced in June 2024. Patients received a wrist splint and information leaflet advising splint removal after 14 days, with instructions to self-refer to the EM clinic if symptoms persisted. This pathway sought to reduce unnecessary attendances, optimise resource utilisation, and maintain safe fracture detection, in line with pathways adopted in other Scottish EDs.Method and Design Data for patients with EM clinic appointments for scaphoid fractures or with an ICD-10 diagnosis of scaphoid fracture, between June and December 2024, were collected retrospectively via local EHR (Clinical Portal and Trakcare). Data from 87 patients were analysed and outcomes compared with the initial 2023 audit of 126 patients.Results and Conclusion 86% (75/87) of patients with clinical scaphoid fracture were discharged via the opt-in pathway. Of these, 32% (24/75) self-referred, and 2 were confirmed fractures. Among the 51 patients who did not self-refer, 5 had confirmed fractures: 4 detected promptly via radiology reporting (all within 2 days of X-ray being performed) and 1 on reattendance to ED a month later. Non-attendance rates also reduced substantially across EM clinic, Virtual Fracture Clinic, and MRI services. Overall, the opt-in pathway significantly reduced resource use and non-attendance while maintaining patient safety. These findings support continuous implementation of patient-directed follow-up in the management of clinical scaphoid fractures.",
  "authors": [
    {
      "affiliations": [
        "Queen Elizabeth University Hospital, Glasgow"
      ],
      "name": "Khai Syuen Chew"
    },
    {
      "affiliations": [
        "Queen Elizabeth University Hospital, Glasgow"
      ],
      "name": "Mellisa Coyle"
    }
  ],
  "title": "3504 Patient-initiated follow-up pathway for clinical scaphoid fracture - a patient-centred service improvement",
  "uid": "288de587-c6eb-5a70-a072-ca545d1d7e30"
}