The construction and implementation of a clinical decision-making algorithm reduces the cost of adult fracture clinic visits by up to £104,800 per year: a quality improvement study

Legg, P; Ramoutar, Darryl; Shivji, Faiz; Choudry, B; Milner, S.

doi:10.1308/rcsann.2016.0276

Cited by 10 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The VFC depends on collaboration with the ED for protocoldriven and leaflet-supported direct discharge of suitable injuries. Patients are also encouraged and empowered to take responsibility for the care of their nonsignificant injury, with virtual care leaflets containing information on rehabilitation and what to do if issues arise [3,[6][7][8]. The ED and neighbouring minor injury units (MIUs) at our institution refer fracture clinic patients to the VFC.…”

Section: Introductionmentioning

confidence: 99%

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

Thomas-Jones¹,

Kocialkowski²,

Dominguez³

et al. 2022

Cureus

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Thomas-Jones¹,

Kocialkowski²,

Dominguez³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…A study published in 2017 showed that a referral algorithm, described as a ‘simple educational intervention’, can effectively reduce the burden of inappropriate referrals and improve service use and cost-efficiency. 24 Reflecting on hospital practice, this toolkit may reduce the number of patients with COVID-19 who are admitted to limited-capacity ICUs by following the patient allocation algorithm ( figure 1 ). Moreover, it has been demonstrated that an algorithm-guided, standardised approach to evaluating patients can save resources without sacrificing patient outcomes or diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

Improving management of hospitalised patients with COVID-19: algorithms and tools for implementation and measurement

et al. 2020

View full text Add to dashboard Cite

BackgroundThe COVID-19 pandemic represents an unprecedented challenge to healthcare systems and nations across the world. Particularly challenging are the lack of agreed-upon management guidelines and variations in practice. Our hospital is a large, secondary-care government hospital in Kuwait, which has increased its capacity by approximately 28% to manage the care of patients with COVID-19. The surge in capacity has necessitated the redeployment of staff who are not well-trained to manage such conditions. There was a great need to develop a tool to help redeployed staff in decision-making for patients with COVID-19, a tool which could also be used for training.MethodsBased on the best available clinical knowledge and best practices, an eight member multidisciplinary group of clinical and quality experts undertook the development of a clinical algorithm-based toolkit to guide training and practice for the management of patients with COVID-19. The team followed Horabin and Lewis’ seven-step approach in developing the algorithms and a five-step method in writing them. Moreover, we applied Rosenfeld et al’s five points to each algorithm.ResultsA set of seven clinical algorithms and one illustrative layout diagram were developed. The algorithms were augmented with documentation forms, data-collection online forms and spreadsheets and an indicators’ reference sheet to guide implementation and performance measurement. The final version underwent several revisions and amendments prior to approval.ConclusionsA large volume of published literature on the topic of COVID-19 pandemic was translated into a user-friendly, algorithm-based toolkit for the management of patients with COVID-19. This toolkit can be used for training and decision-making to improve the quality of care provided to patients with COVID-19.

show abstract

“…Several studies have shown significant cost savings can be made through the use of virtual clinics [5] . In addition, the use of virtual clinics has been shown to significantly improve waiting times for first clinical review especially in foot and ankle fracture cases [6,7] . With the growing interest in the balance between developing safe and robust patient pathways whilst reducing costs, there is a balance to be struck between cost savings on the one hand and safe effective care on the other.…”

Section: Discussionmentioning

confidence: 99%

The use of virtual telephone clinic in elective foot and ankle follow up

Ahmed¹,

Teoh²

2020

Hong Kong J Orthop Res

View full text Add to dashboard Cite

Introduction: Virtual clinics have been shown to be safe and cost-effective in many specialties. Many articles have been found in the literature about its usefulness in fracture occasions, but we have not found many discussing its effectiveness in foot and ankle elective cases follow ups. The aim of this audit is to show its safety, clinical outcomes, and complications. Patients and methods: In Princess Alexandra Hospital, UK, we collected data from COSMICS system which contained patient contact details, PACS and case note management system were used to see previous investigations and dictation letters and to check the outcome of the virtual clinic. Results: 292 patients were included, from them 167 were females (57.8%), while 125 were males (42.8%).148 patients were contacted by mobile phones (50.7%), 41 patients (14%) were contacted by landline, and unfortunately 67 patients (22.9%) have not picked the phone. From the 292 patients, 232 (79.5%) patients were dischargedone patient requested to be seen face to face. 40 patients (14%) were listed for being reviewed and 12 patients were listed for surgery (4.1%). 8 patients were listed for having PRP/local anesthetic/ steroid injection. Conclusion: Virtual telephone clinics for elective foot and ankle cases are very effective way for management of busy clinics with long waiting lists provided that it was run safely. We reported from our study the rules by which we run it and many benefits and drawbacks were also highlighted with our recommendations to maximize the gain from it.

show abstract

The construction and implementation of a clinical decision-making algorithm reduces the cost of adult fracture clinic visits by up to £104,800 per year: a quality improvement study

Cited by 10 publications

References 12 publications

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

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

Improving management of hospitalised patients with COVID-19: algorithms and tools for implementation and measurement

The use of virtual telephone clinic in elective foot and ankle follow up

Contact Info

Product

Resources

About