One and done? Outcomes from 3961 patients managed via a virtual fracture clinic pathway for paediatric fractures

Abstract

Purpose The aim of this paper is to describe our experience with a virtual fracture management pathway in the setting of a paediatric trauma service. Methods All patients referred to the virtual fracture clinic service from the Paediatric Emergency Department (PED) were prospectively collected. Outcome data of interest (patients discharged, referred for urgent operative treatment, referred back to emergency department for further evaluation, referred for face-to-face clinical assessment and all patients who re-presented on an unplanned basis for further management of the index injury) were compiled and collated. Cost analysis was performed using established costing for a virtual fracture clinic within the Irish Healthcare System. Results There were a total of 3961 patients referred to the virtual fracture clinic from the PED. Of these, 70% (n = 2776) were discharged. In all, 26% (n = 1033) were referred to a face-to-face appointment. Of discharged patients, 7.5% (n = 207) required an unplanned face-to-face evaluation. A total of 0.1% (n = 3) subsequently required operative treatment relating to their index injury. Implementation of the virtual fracture clinic model generated calculated savings of €254 120. Conclusion This prospective evaluation has demonstrated that a virtual fracture clinic pathway for minor paediatric trauma is safe, effective and brings significant cost savings. Level of Evidence II

How safe and effective are paediatric virtual fracture clinics? A systematic review

“…Five of the studies reported on the time between initial presentation and review in the VFC and all of these were within 72 h, indicating high compliance with the BOAST 7 guidelines ( 25 , 27 – 30 ).…”

“…Three studies reported on outcomes after the VFC. The rate of direct discharge from VFC without the need for a further appointment ranged from 70% to 75% ( 27 – 29 ). This resulted in the saving of the following number of F2F fracture clinic appointments: 78/104 ( 28 ), 2,770/3,961 ( 27 ) and 33/44 ( 29 ).…”

“…The rate of direct discharge from VFC without the need for a further appointment ranged from 70% to 75% ( 27 – 29 ). This resulted in the saving of the following number of F2F fracture clinic appointments: 78/104 ( 28 ), 2,770/3,961 ( 27 ) and 33/44 ( 29 ). Robinson et al estimate that three VFC patients can be seen in the time it takes to review one F2F fracture clinic patient ( 26 ).…”

“…Despite the initial unfamiliarity with the VFC protocol, Kennedy et al reported that over time the number of patients referred to the VFC and the numbers discharged from the VFC increased. This indicates increased clinician confidence with the pathway over time ( 27 ). Only one report of safeguarding was mentioned by Aboelmagd et al, where one family refused to engage with the pathway and were uncontactable by phone, initiating the safeguarding process ( 28 ).…”

Virtual fracture clinics: be vigilant for the ligamentous elbow injury

“…In some trusts, common fracture patterns such as undisplaced radial head/neck fractures are deemed suitable for direct discharge from VFC with advice leaflets on expected recovery. The VFC pathway is mostly successful, with an infrequent need for unplanned face-to-face consultation and low reported late surgical intervention rates of 0.1–1% [ 3 , 4 ]. However, we contend that in the case of high-energy trauma, even where there is minimal radiographic fracture displacement, there should be a low threshold for referral to the on-call orthopaedic team or facilitation of face-to-face fracture clinic review to avoid missing concomitant injury.…”