Practice report: Primary urgent care fracture clinic

Background: Fractures, ranging from minor non-displaced injuries to complex fractures requiring hospital care, contribute significantly to the growing burden on emergency departments (EDs). Primary urgent care centres (PUCCs) are emerging as potential cost-effective alternatives for managing uncomplicated fractures. These clinics offer diagnostic imaging, treatment, and referral pathways, reducing strain on EDs. However, there is limited evidence regarding the demographic patterns, referral sources, wait times, and outcomes in PUCC-based fracture clinics in Australia.

Objectives: This study aimed to analyse retrospective fracture management cases in a PUCC setting co-located with general practice in Queensland, Australia. Specifically, it examined patient demographics, diagnostic patterns, referral pathways, wait times, and hospital transfer rates to better understand the utility of PUCCs in managing uncomplicated fractures.

Methods: A retrospective chart review of 1,011 patient appointments at a PUCC fracture clinic from January 1 to September 30, 2024, was conducted. Data included patient demographics, diagnoses, referral sources, and wait times from referral to first visit. Descriptive statistics and k-means clustering analysis were used to identify patterns in patient presentations, referral delays, and injury types. Outcomes such as hospital transfers and discharge rates were analysed.

Results: Of the 1,011 fracture clinic appointments, 476 (47.1%, missing data n=1) were new patient cases, with an average patient age of 32 years (range: 0–95). Wrist fractures were the most common diagnosis (24.5%), particularly in younger and older cohorts. Referral sources included internal (onsite) and external primary healthcare practitioners (e.g. GPs and NPs). Median wait time from referral to appointment was 5 days (IQR: 3–7 days), with outliers extending beyond 40 days due to system and patient factors. Notably, only 1.5% (n=7) of new cases required hospital transfer, suggesting a high rate of effective outpatient management. Females outnumbered males in older cohorts (≥44 years), while males predominated in younger cohorts (0–17 years).

Conclusions: PUCC fracture clinic can effectively manage uncomplicated fractures, reduce ED burden and ensure timely care. The low hospital transfer rate demonstrates that this site-specific PUCC, with appropriate specialist presence, training and access to immediate diagnostics, can efficiently treat uncomplicated outpatient fractures. It also highlighted the importance of effective communication in supporting efficient referral pathways, and the benefit of education and training, for not only the PUCC workforce, but also for the referrers to the fracture clinic, to ensure timely and appropriate care starts at first contact within the healthcare system.

Implications: PUCCs represent a scalable model for managing uncomplicated fractures, particularly in underserved areas. Enhanced communication between referrers and PUCCs, along with workforce training and streamlined referral pathways, can improve fracture care access and reduce delays to appropriate treatment. These findings contribute to the evidence base for PUCCs as a service option to hospitals, offering a cost-effective and patient-centred alternative for fracture care.