Lessons From the Virtual Fracture Clinic: An Efficient Model With Satisfied Patients

Abstract

The virtual fracture clinic (VFC) can be an effective means of managing specific musculoskeletal injuries, including through protocol-driven direct discharge from the emergency department (ED) or minor injury unit (MIU). This study aimed to measure the efficiency of the VFC triage process while quantifying patient satisfaction after direct discharge from the VFC without routine face-to-face review. MethodsWe conducted a retrospective analysis of a prospectively collected database to ascertain VFC outcomes for 9064 patients from February 2017 to July 2018. We analysed consultant variation in VFC review and the mean time taken per patient. Patient satisfaction was investigated in 100 chronological patients initially managed via the VFC. ResultsThe mean time to triage each patient was 74 seconds, and a mean of 503 patients was triaged each month. The telephone helpline received a mean of 0.9 calls per week. Seventy-seven percent of patients stated they were happy to be managed without a fracture clinic appointment, and 82% of patients received virtual leaflets in the ED or MIU as per protocol. The number of fracture clinic appointments was reduced by 24% as patients were discharged directly or seen instead by allied health professionals. The median patient satisfaction with VFC management was 90%, and the mean satisfaction with VFC communication was 80%. ConclusionVirtual review of fracture clinic referral enables stratification of patients according to clinical urgency and saves patients from attending unnecessary appointments. This is achieved in a patient population generally satisfied with their overall management. Our study results support the growing trend of VFCs as pivotal systems in streamlining the care of musculoskeletal injuries while adhering to British Orthopaedic Association Standards for Trauma guidelines for Fracture Clinic Services.

The effects of a Virtual Fracture Care review protocol on secondary healthcare utilization in trauma patients requiring semi-acute surgery: a retrospective cohort study

“…The reduction in radiographs in the VFC group aligns with results from previous studies and can be attributed to the more organized and supervised decision-making process during the VFC review meeting, similar to the reduction of follow-up appointments ( 28 , 34 ). Additionally, the introduction of this protocol has led to a shift in time and place for CT scans, from the follow-up treatment phase in the outpatient clinic towards the initial treatment phase in the ED.…”

The effects of a Virtual Fracture Care review protocol on secondary healthcare utilization in trauma patients requiring non operative treatment: a retrospective cohort study

“…patients who experience barriers to communication due to language differences or who have limited understanding of the recovery process). (31) Similar to the reduction in follow-up appointments, the reduction in radiographs during follow-up treatment in the VFC group aligns with results from previous studies and can most likely be attributed to the more organized and supervised decision-making process during the VFC review meeting (24,25).…”

“…However, these mostly focused on the initial treatment phase and the referral of patients to the most appropriate caregiver at the start of the treatment process. (11,14,24,25) Our results complement these studies and show that the VFC review protocol can improve e ciency of hospital follow-up treatment.…”

Can a Fully Electronic Patient Record-Based Virtual Fracture Clinic Increase Compliance With British Orthopaedic Association Guidelines for the Assessment of Acute Orthopaedic Trauma Patients?

“…There have been numerous studies that have established the VFC as a cost-effective and efficient way of increasing adherence to the BOA and National Institute for Health and Care Excellence (NICE) standards [6]. It has also been shown to improve patient satisfaction, through reduced unnecessary face-to-face appointments, and improve patient safety with fewer cases of patients not attending their follow-up clinics [7].…”