scholarly journals P27: INTRODUCTION OF A PILOT VIRTUAL FRACTURE CLINIC: A TIME AND COST ANALYSIS

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
A McCarthy ◽  
L Muller ◽  
K O'Shea ◽  
P Keeling
Keyword(s):  
Cost Analysis ◽  
Clinical Performance ◽  
Waiting Times ◽  
Soft Tissue Injuries ◽  
Missed Appointments ◽  
Radial Head Fractures ◽  
Fracture Clinic ◽  
Measured Time ◽  
Satisfaction Rates ◽  
Virtual Fracture Clinic

Abstract Introduction The British Orthopaedic Association Standards for Trauma and Orthopaedics(BOAST) have produced guidelines advising that all patients be reviewed by an orthopaedic consultant within 72 hours of presentation. However, data from traditional fracture clinics rarely fulfil this criterion. Furthermore, data from the National Health Service(NHS) has determined that traditional fracture clinics have become unfit for purpose with low patient satisfaction rates, excessive waiting times and over 6.9 million missed appointments every year. Our aim is to test the feasibility of a virtual fracture clinic(VFC) with a view to reducing service costs and improving adherence to BOAST guidelines specified timeline for orthopaedic consultant review. Method A retrospective analysis of 103 patients referred to our pilot VFC from January 1st to 31st 2019 was carried out. We included shoulder dislocations, clavicle injuries, simple distal radius fractures, radial head fractures, metacarpal and metatarsal injuries, undisplaced fractures of the medial and lateral malleolus of the ankle and soft tissue injuries. The primary outcome measured time from presentation to review by an orthopaedic consultant. A cost analysis was also performed to estimate the overheads and potential savings associated with VFC introduction. Statistical analysis was done via SPSS. Result Following VFC establishment, time from ED presentation to review by orthopaedic consultant reduced from a mean of 229 hours to 72 hours(P=0.0001). Cost analysis demonstrated that the VFC created savings of €3170 per week, amounting to projected savings of €38,040. Conclusion VFC has the potential to improve clinical performance while delivering substantial financial savings. Take-home message Virtual fracture clinic improves patients review times bringing them in line with BOAST guidelines while providing significant reductions in overheads leading to potential savings of over 38,000 euro.

scholarly journals AB154. The impact of a pilot virtual fracture clinic: a time and cost analysis

2020 ◽  
Vol 4 ◽  
pp. AB154-AB154
Author(s):  
Andrea Mc Carthy ◽  
Laura Muller ◽  
Kieran O’Shea ◽  
Parnell Keeling
Keyword(s):  
Cost Analysis ◽  
Fracture Clinic ◽  
The Impact ◽  
Virtual Fracture Clinic

scholarly journals Virtual fracture clinic delivers British Orthopaedic Association compliance

2017 ◽  
Vol 99 (1) ◽  
pp. 51-54 ◽  
Author(s):  
J Holgate ◽  
S Kirmani ◽  
B Anand
Keyword(s):  
Emergency Department ◽  
Closed Loop ◽  
Waiting Times ◽  
District General Hospital ◽  
Fracture Clinic ◽  
Mean Waiting Time ◽  
The Cost ◽  
Pro Forma ◽  
Virtual Fracture Clinic ◽  
British Orthopaedic Association

INTRODUCTION The British Orthopaedic Association recommends that patients referred to fracture clinic are thereafter reviewed within 72 hours. With the aim of improving care by seeking to meet this target, waiting times for fracture clinic appointments in a district general hospital were audited prospectively against this national guideline, with the intervening implementation of a virtual fracture clinic. MATERIALS AND METHODS The study was conducted as a prospective closed-loop audit in which the second cycle took place several months after a change in the clinical pathway for all referrals from the emergency department to fracture clinic. Data were gathered in real-time via a pro forma during fracture clinic consultations. RESULTS The first cycle demonstrated a non-compliant mean waiting time of 10.7 days, with 6% of patients being seen within the 72-hour target. Following the implementation of the virtual fracture clinic, the second cycle found that all patients were reviewed within the 72-hour target (mean 1.3 days). DISCUSSION The improvement in performance was delivered with no increase in clinic capacity. The cost of implementation was negligible. CONCLUSION A simple virtual fracture clinic model delivered a significant reduction in waiting times and achieved compliance with the British Orthopaedic Association guideline. Similar results could be achieved in subsequent deployment elsewhere in the NHS.

scholarly journals AB261. Introduction of a virtual fracture clinic: a time and cost analysis

2020 ◽  
Vol 4 ◽  
pp. AB261-AB261
Author(s):  
Andrea Mc Carthy ◽  
Laura Muller ◽  
Kieran O’Shea ◽  
Parnell Keeling
Keyword(s):  
Cost Analysis ◽  
Fracture Clinic ◽  
Virtual Fracture Clinic

scholarly journals 688 Rapid Implementation of Virtual Fracture Clinic During COVID 19 Reduces Both Face-To-Face Appointments and Facilitates Rapid Feedback and Education to Be Delivered to The Emergency Department

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Havenhand ◽  
L Hoggett ◽  
A Bhutta
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Prospective Data ◽  
Fracture Clinic ◽  
Face To Face ◽  
Return Rates ◽  
Acute Hospitals ◽  
Virtual Fracture Clinic ◽  
Improve Patient

Abstract Introduction COVID-19 has dictated a shift towards virtual clinics. Pennine Acute Hospitals NHS Trust serves over a million patients with a significant number of face-to-face fracture clinics. Introduction of a Virtual Fracture Clinic (VFC) reduces hospital return rates and improves patient experience. The referral data can be used to give immediate monthly feedback to the referring department to further improving patient flow. Method Prospective data was collected for all referrals to VFC during March 2020. Data included referral diagnosis, actual diagnosis, referrers grade, and final outcome. Results 630 referrals were made to VFC. 347 (55%) of those referrals were directly discharged without the need for physical consultation. Of these 114 (32%) were injuries which can be discharged by the Emergency Department with an advice leaflet using existing pathways. Of the remaining discharges 102 (29%) were query fractures or sprains; and 135 (39%) were minor fractures; which needed only advice via a letter and no face to face follow up. Conclusions Implementation of VFC leads to a decrease in physical appointments by 55% saving 347 face to face appointments. The new system has also facilitated effective audit of referrals in order to further improve patient flow from the Emergency Department via feedback mechanisms and education.

scholarly journals AB066. SOH21AS168. Remote delivery of the satellite virtual fracture clinic—a pilot report of the first 500 cases

2021 ◽  
Vol 5 ◽  
pp. AB066-AB066
Author(s):  
Andrew Jerome Hughes ◽  
Darren Patrick Moloney ◽  
Caroline Fraser ◽  
Joan Dembo ◽  
Andrew Hughes ◽  
...  
Keyword(s):  
Fracture Clinic ◽  
Virtual Fracture Clinic

341 Alder Hey Experience of Paediatric Virtual Fracture Clinic During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Stead ◽  
M Ashraf ◽  
S Gandham ◽  
M Khattak ◽  
C Talbot
Keyword(s):  
Patient Contact ◽  
Fracture Clinic ◽  
Social Challenges ◽  
Face To Face ◽  
Elbow Injuries ◽  
Rapid Transition ◽  
Clavicle Fractures ◽  
Alder Hey ◽  
Virtual Fracture Clinic

Abstract Introduction The SARS-CoV2/COVID-19 pandemic represented an unprecedented emergency prompting a drive to minimise non-essential patient contact and the need for a virtual fracture clinic (VFC); an uncommon practice in paediatric units. Management of paediatric fractures requires a greater degree of vigilance to safeguard children. The current climate has created social challenges that theoretically increase the risk of harm and exploitation to children. This study investigates VFC in the management of paediatric fractures to determine the efficiency of such a process and the risk of safeguarding. Method A protocol was devised in affiliation with BSCOS for the immediate management and streamlining of paediatric fractures into VFC. We retrospectively audited 235 VFC consults over a 1-month period. Patient sex was roughly evenly distributed, and age ranged from 9 months to 16 years (mean 8.4 years). Results 42% of patients were recalled for a face-to-face (F2F) review (26% expedited), primarily for clinical assessment, plaster complaints and imaging requirements. 33% were discharged and 15% continued follow-up in VFC. All clavicle fractures were discharged. Forearm, hand, foot and elbow injuries were more likely to be discharged. Lower leg, upper arm and knee presentations more frequently required a F2F review. 2.3% of cases required safeguarding reviews. Conclusions Given the rapid transition to VFC without the use of triage we have determined a number of non-complex fractures safely managed and discharged via VFC. The low percentage of recall due to safeguarding concern highlights this may not be a barrier to the continuation of virtual care outside of the context of a pandemic.

scholarly journals Effect of a redesigned fracture management pathway and 'virtual' fracture clinic on ED performance

BMJ Open ◽  
2014 ◽  
Vol 4 (6) ◽  
pp. e005282-e005282 ◽  
Author(s):  
J. Vardy ◽  
P. J. Jenkins ◽  
K. Clark ◽  
M. Chekroud ◽  
K. Begbie ◽  
...  
Keyword(s):  
Fracture Clinic ◽  
Fracture Management ◽  
Virtual Fracture Clinic

scholarly journals A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting

2016 ◽  
Vol 98 (03) ◽  
pp. 187-191 ◽  
Author(s):  
L Wood ◽  
P Hendrick ◽  
B Boszczyk ◽  
E Dunstan
Keyword(s):  
Patient Outcomes ◽  
Care Setting ◽  
Surgical Intervention ◽  
Waiting Times ◽  
Service Evaluation ◽  
Surgery Patient ◽  
Discharged Patients ◽  
Secondary Care Setting ◽  
The Uk ◽  
Satisfaction Rates

Introduction Spinal orthopaedic triage aims to reduce unnecessary referrals to surgical consultants, thereby reducing waiting times to be seen by a surgeon and to surgical intervention. This paper presents an evaluation of a spinal orthopaedic triage service in the third largest spinal unit in the UK. Methods A retrospective service evaluation spanning 2012 to 2014 was undertaken by members of the extended scope practitioner (ESP) team to evaluate the ESPs’ ability to manage patient care independently and triage surgical referrals appropriately. Data collected included rates of independent management, referral rates for surgical consideration and conversion to surgery. Patient satisfaction rates were evaluated retrospectively from questionnaires given to 5% of discharged patients. Results A total of 2,651 patients were seen. The vast majority (92%) of all referrals seen by ESPs were managed independently. Only 8% required either a discussion with a surgeon to confirm management or for surgical review. Of the latter, 81% were considered to be suitable surgical referrals. A 99% satisfaction rate was reported by discharged patients. Conclusions ESP services in a specialist spinal service are effective in managing spinal conditions conservatively and identifying surgical candidates appropriately. Further research is needed to confirm ESPs’ diagnostic accuracy, patient outcomes and cost effectiveness.

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