E-referral to the QVH hand trauma team for clinicians

The form below should be used by clinicians to refer patients with closed hand injuries to the Queen Victoria Hospital hand trauma service. Referrals are accepted from settings including A&E, Urgent Care Centres, Minor injury Units, and GP surgeries if the following criteria is met.

Inclusion criteria

Referral should be made within three weeks of injury
Closed hand fractures (digits / metacarpals / carpal bones excluding scaphoid)
Mallet injuries
Closed tendon ruptures
Home post code within the following catchments: ME, CT, TN, BN, GU, PO, KT, CR, BR, DA RH

Exclusion criteria

Open injuries of any type, (including open fractures, penetrating injuries or hand/ finger lacerations)
Infections of any kind
Dislocations
Neurovascularly compromised digits
Any injuries requiring immediate treatment (e.g. replantation)
Scaphoid or distal radius/ulna fractures (these should be referred to your local Orthopaedic unit)

If your patient meets any of the criteria please complete this form and email back to qvh.closedhandinjuries@nhs.net We will review the referral within 48 working hours and contact the patient directly with an appointment.

If your patient meets any of the exclusion criteria please call 01342 414000 and ask to speak to the trauma coordinator.

Non-traumatic cases requiring elective surgery/treatment e.g. Dupuytren’s contracture, carpal tunnel or trigger finger, should be referred using the usual NHS e-booking system

"*" indicates required fields

Patient information

Patient's first name*

Patient's surname*

Patient's NHS number (if you do not have a number please call the trauma coordinator on 01342 414000)*

Patient's date of birth*

Patient's address*

Patient's postcode*

Patient’s contact number*

Patient's email address

GP name

GP address

Date of injury*

Date seen and treated*

Details of injury/symptoms from clinical examination*

Please note referrals will only be accepted for closed, infection-free injuries which are no older than 3 weeks.

Has an X-Ray been done?*

Yes

If yes, which hospital?*

True lateral included?*

Yes

(required for all metacarpal fractures)

If not available on Sectra, has an IEP been arranged?*

Yes

Past medical history to be aware of

Referrer information

Your name*

Organisation*

Your NHS email address*

Your contact number*

Comments

This field is for validation purposes and should be left unchanged.

We will ensure that any information you provide to us will be held securely and will only be accessed by specifically authorised members of staff. If you have any questions related to the security of your information please contact our Data Protection Officer at qvh.dataprotection@nhs.net

Queen Victoria Hospital NHS Foundation Trust
Holtye Road
East Grinstead
West Sussex
RH19 3DZ

If you experience any difficulties with this form please call 01342 414000 and ask to speak to the trauma coordinator.

E-referral to the QVH hand trauma team for clinicians

Inclusion criteria

Exclusion criteria

Patient information

Referrer information

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