Improving Wrist Injury Pathways (I-WIP)

Wrist injuries are a big and common problem for patients and the NHS, with around 70,000 patients a year in the UK going to hospitals with wrist pain after an injury and normal x-rays.

Often, when doctors check, the wrist is very painful, but the x-rays look normal. Current guidelines now recommend that this large group of people should have MRI scans (magnetic resonance imaging = very detailed scanning) early on.

When doctors do use MRI scans early on, patients feel less worried, and happier with their treatment. It also saves the NHS money. But our recent study tells us that doctors do not often do this – only 13% of UK centres can currently provide early MRI scans for these patients. We need to understand this complex problem better, before trying to fix it.

Our project consists of a first part of data gathering to better understand the situation and this is well underway. The second part will then turn this information into action by co-designing a complex intervention to address this implementation gap.

Aims and objectives

Develop a better understanding of current wrist injury pathways in the UK.
Co-design a complex intervention to address the implementation gap.

The first part of the project has been completed and can be read in the 'selected publications' section on this website. Early MRI was seen as a ‘win for everyone’. For patients, the win encompassed the relief of a speedy diagnosis which helped them to get better. Staff saw early MRI as a win because it ‘revolutionised care’ and ‘reduced the clinic footprint’. The study also described the key ingredients in delivering an effective wrist injury pathway. We are now using the study's results in further work to design a 'complex intervention' to help NHS centres to improve their wrist injury pathways for patients (aim 2 above).