ESTABLISHMENT OF VIRTUAL FRACTURE CLINIC IN PRINCESS ROYAL HOSPITAL TELFORD: EXPERIENCE AND RECOMMENDATIONS DURING THE FIRST 9 MONTHS
Keywords:Key words: Virtual Fracture Clinic, Trauma and Orthopaedics, Covid-19
AbstractBackground: Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety. Methods: A protocol was developed by the clinical team in collaboration with Advanced Physiotherapy Practitioners (APP) on how to manage common musculoskeletal presentations to A&E prior to COVID as part of routine service development. Patients broadly triaged into 4 categories; discharge with advice, referral to VFC, referral to face to face clinic or discussion with on call team. The first 9 months of data were analysed to assess types of injury seen and outcomes. Results: In total 2489 patients were referred to VFC from internal and external sources. Seven hundred and thirty-four patients were discharged without follow-up and 182 patients were discharged for physiotherapy review. Only 3 patients required admission. Regarding follow-ups, 431 patients had a virtual follow-up while 1036 of patients required further face to face follow up. Eighty-seven patients were triaged into subspecialty clinics. Thirty-seven patients were felt to have been referred inappropriately. Discussion: British Orthopaedic Association guidelines suggest all patients need to be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review, the remaining patients were appropriately followed up. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient as well as make the most of the resources available.
Logishetty K. Adopting and sustaining a Virtual Fracture Clinic model in the District Hospital setting – a quality improvement approach. BMJ Qual Improv Rep 2017;6(1):u220211.
Accident and Emergency Attendances in England - 2007-2008, Experimental statistics [Internet]. NHS Digital. [cited 2021 July]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/hospital-accident--emergency-activity/2007-2008
BOAST Guidelines: fracture clinic services, August 2013. [Internet]. [cited 2021 July]. Available from: https://www.boa.ac.uk/uploads/assets/7ded8f00-987e-42d5-a389e739b1e03b47/ec9d4564-4fa7-4d08-aef4efc3cede7d53/fracture%20clinic%20services.pdf
Rhind JH, Ramhamadany E, Collins R, Govilkar S, Dass D, Hay S. An analysis of virtual fracture clinics in orthopaedic trauma in the UK during the coronavirus crisis. EFORT Open Rev 2020;5(7):442–8.
Harrop V. Virtual healthcare delivery: defined, modeled, and predictive barriers to implementation identified. Proc AMIA Symp 2001;244–8.
NHS England. Five Year Forward View: NHS England; 2014 [cited 2016 Oct 24]. Available from: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008;27(3):759–69.
Vardy J, Jenkins PJ, Clark K, Chekroud M, Begbie K, Anthony I, et al. Effect of a redesigned fracture management pathway and ‘virtual’ fracture clinic on ED performance. BMJ Open 2014;4(6):e005282.
Glasgow Royal Infirmary Orthopaedic Department. Fracture Clinic Redesign 2015 [cited 2016 March 23]. Available from: http://www.fractureclinicredesign.org/
Gamble D, Jenkins PJ, Edge MJ, Gilmour A, Anthony IC, Nugent M, et al. Satisfaction and functional outcome with “self-care” for the management of fifth metacarpal fractures. Hand (N Y) 2015;10(4):607–12.
NHS England. Brighton and Sussex NHS Trust Virtual Fracture Clinic 2016 [Internet]. [cited 2016 Oct 24]. Available from: https://www.england.nhs.uk/challengeprizes/about/winners-1516/virtual-fracture-clinic/
Jenkins P, Gilmour A, Murray O, Anthony I, Nugent MP, Ireland A. The Glasgow Fracture Pathway: a virtual clinic. BJJ News 2014;2:22–4.
Khan SA, Asokan A, Handford C, Logan P, Moores T. How useful are virtual fracture clinics?: a systematic review. Bone Jt Open 2020;1(11):683–90.
O' Reilly M, Breathnach O, Conlon B, Kiernan C, Sheehan E. Trauma assessment clinic: Virtually a safe and smarter way of managing trauma care in Ireland. Injury 2019;50(4):898–902.
McAuliffe O, Lami M, Lami T. The impact of virtual fracture clinics on medical education: a medical student perspective. Med Educ Online 2016;21:30950.
Murray O, Christen K, Marsh A, Bayer J. Fracture clinic redesign: improving standards in patient care and interprofessional education. Swiss Med Wkly 2012;142:w13630.