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.

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 1518 The Use of OrthoPathway, Decision Support Software, To Reduce Variation in Practice, Optimise Patient Care and Reduce Face-To-Face Appointments in Trauma and Orthopaedics

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Jones ◽  
W Griffiths-Jones
Keyword(s):  
Emergency Department ◽  
Decision Support ◽  
Web Application ◽  
Clinical Pathways ◽  
Management Plan ◽  
National Guidelines ◽  
Fracture Clinic ◽  
Face To Face ◽  
Musculoskeletal Problems

Abstract Introduction Musculoskeletal problems account for 3.5million Emergency Department attendances annually. Front-line staff are under pressure, faced with complex decisions with limited supportive tools. Without adequate support there is greater variation in practice, poor patient outcomes, longer Emergency Department stays and unnecessary follow-up. OrthoPathway is a web application that enables the production of editable decision support pathways. We have published over 50 Consultant designed, locally approved, interactive pathways. Patient-facing staff can use these to follow national guidelines, by answering questions to establish appropriate treatments. Method New and follow-up fracture clinic patients were audited over a one-week period. Clinic letters and clerking documents were analysed to identify the diagnosis and management plan. From information and radiographs available OrthoPathway was used to generate a management plan, used as the audit standard. Results 78 new patients and 83 follow-up patients were seen in fracture clinic over a one-week period. Clinical pathways were available on OrthoPathway for 42% of new patients and 40% of follow-up patients. Variation in practice was seen in 42% of new patients and 59% of follow-up patients. The associated saving in appointments was 11 and 21 and in the new and follow-up patients, respectively. Conclusions We have shown that OrthoPathway has the potential to reduce face-to-face appointments by 20%, with its current utilisation. Through the deployment of a full set of pathways we anticipated a reduction of greater than 40%, which is particularly pertinent given the current COVID-19 pandemic. This highlights the benefits of Consultant approved decision support pathways published on OrthoPathway.

scholarly journals ENT Telephone Clinics During the Coronavirus Pandemic: An Analysis of 400 Telephone Consultations at a District General Hospital

2021 ◽  
pp. 014556132110280
Author(s):  
Narek Sargsyan ◽  
Dilhara Karunaratne ◽  
Alisha Masani ◽  
Lauren Howell ◽  
Madi Yousif
Keyword(s):  
Health Care ◽  
Patient Flow ◽  
District General Hospital ◽  
Face To Face ◽  
Throat Symptom ◽  
Specialist Health Care ◽  
Patient Groups ◽  
Improve Patient ◽  
Nose And Throat

Background: The COVID-19 pandemic led to the introduction of telephone consultations in order to provide specialist health care remotely. This study analyses the outcomes of ear, nose, and throat (ENT) telephone consultations. Methods: Retrospective analysis was undertaken of 400 ENT telephone consultations. Results: All 2-week-wait neck or face lump patients underwent imaging and 78% were successfully discharged. 80% of vertigo patients and 100% of 2-week-wait throat symptom patients were offered face-to-face consultations. All primary hyperparathyroidism patients were managed remotely, being discharged, or with telephone follow-up. The majority of routine referrals were managed without the need for face-to-face consultation. Conclusion: Vertigo patients and 2-week-wait throat symptom patients should be offered a face-to-face consultation in the first instance. For patients with neck or face lumps, initial referral for imaging may improve patient flow and facilitate safe discharge. It is appropriate to continue with telephone consultations for all other patient groups.

scholarly journals Optimizing orthopedic trauma care delivery during the COVID-19 pandemic. A closed-loop audit of implementing a virtual fracture clinic and fast-track pathway in a Dutch level 2 trauma center

2021 ◽  
Vol 6 (1) ◽  
pp. e000691
Author(s):  
Thijs H Geerdink ◽  
Dorien A Salentijn ◽  
Kristin A de Vries ◽  
Philou C W Noordman ◽  
Johanna M van Dongen ◽  
...  
Keyword(s):  
Waiting Time ◽  
Fast Track ◽  
Closed Loop ◽  
Treatment Plan ◽  
Trauma Patients ◽  
Orthopedic Trauma ◽  
Fracture Clinic ◽  
Face To Face ◽  
Virtual Fracture Clinic

BackgroundGuidelines concerning outpatient management of patients during the coronavirus pandemic required minimized face-to-face follow-up and increased remote care. In response, we established a virtual fracture clinic (VFC) review for emergency department (ED) patients with musculoskeletal injuries, meaning patients are reviewed ‘virtually’ the next workday by a multidisciplinary team, instead of routine referral for face-to-face fracture clinic review. Patients wait at home and are contacted afterwards to discuss treatment. Based on VFC review, patients with minor injuries are discharged, while for other patients an extensive treatment plan is documented using injury-specific care pathways. Additionally, we established an ED orthopedic trauma fast-track to reduce waiting time. This study aimed to evaluate the extent to which our workflow supported adherence to national coronavirus-related guidelines and effects on ED waiting time.MethodsA closed-loop audit was performed during two 4-week periods using predefined standards: (1) all eligible ED orthopedic trauma patients are referred for VFC review; (2) reached afterwards; and follow-up is (3) patient initiated, or (4) performed remotely, whenever possible. Total ED waiting time, time to review, time for review, and time after review were assessed during both audit periods and compared with previous measurements.ResultsDuring both audits, the majority of eligible ED patients were referred for VFC review (1st: n=162 (88.0%); 2nd: n=302 (98.4%)), and reached afterwards (1st: 98.1%; 2nd: 99.0%). Of all referred patients, 17.9% and 13.6% were discharged ‘virtually’ during first and second audits, respectively, while 45.0% and 41.1% of scheduled follow-up appointments were remote. Median total ED waiting time was reduced (1st: −36 minutes (p<0.001); 2nd: −33 minutes (p<0.001)). During the second audit, median ED time to review was reduced by −13 minutes (p<0.001), as well as time for review: −10 minutes (p=0.019).DiscussionIn line with national guidelines, our VFC review allowed time-effective review and triage of the majority of ED orthopedic trauma patients, supporting patient-initiated and remote follow-up, whenever possible. ED waiting time was reduced after implementing the VFC review and orthopedic trauma fast-track.Level of evidenceIV.

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

2021 ◽  
pp. 1-8
Author(s):  
Jim Kennedy ◽  
Carol Blackburn ◽  
Michael Barrett ◽  
Patrick O’Toole ◽  
David Moore
Keyword(s):  
Emergency Department ◽  
Operative Treatment ◽  
Outcome Data ◽  
Level Of Evidence ◽  
Fracture Clinic ◽  
Face To Face ◽  
Paediatric Trauma ◽  
Trauma Service ◽  
Fracture Management ◽  
Virtual Fracture Clinic

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

scholarly journals Quality and Evaluation Report: Virtual Fracture Clinic at Wythenshawe Hospital

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Christian Warner ◽  
Anand Pillai
Keyword(s):  
Discharge Rate ◽  
Royal Infirmary ◽  
Fracture Clinic ◽  
Face To Face ◽  
Discharge Rates ◽  
Level Of Satisfaction ◽  
Rate Versus ◽  
Number Of Patients ◽  
Virtual Fracture Clinic

 Background: Following its introduction at Glasgow Royal Infirmary in 2011, the Virtual Fracture Clinic model of managing outpatient musculoskeletal injuries has grown significantly in popularity. Wythenshawe Hospital introduced this model to their orthopaedic department in 2015. Aims: How do individual consultants vary in terms of discharge rate versus face-to-face follow up when reviewing cases in a Virtual Fracture Clinic? To assess patients’ level of satisfaction with the management of their injury under a Virtual Fracture Clinic System. Methods: A retrospective study of a cohort of patients over 12 months from 11th May 2017 to 11th May 2018. Data regarding the number of patients reviewed in Virtual Fracture Clinic during this time was collected and the numbers of patients discharged or recalled for follow up analysed. A telephone questionnaire based on the NHS Friends and Family Test was collected from 50 patients within this cohort to assess overall satisfaction with their care. Results: 3361 patients were referred to virtual fracture clinic during the inclusion period. The mean percentage of cases discharged from virtual fracture clinic is 30.4% with a median of 30.5%. The rates of discharge ranged from Consultant G at 13% to Consultant K at 39%. 88% of patients would recommend this service to their friends and family and 80% would rate the service at the level of good or excellent. Conclusion: A virtual fracture clinic model has been successfully implemented at Wythenshawe saving approximately 1157 appointments in 12 months. There is significant variation in discharge rates between consultants which appears to be influenced by the number of patients seen. Individual factors which affect this require further investigation. Patients are very satisfied with their care through the Virtual Fracture Clinic at Wythenshawe Hospital and an overwhelming majority would recommend this to others.

scholarly journals Do automatic push notifications improve patient flow in the emergency department? analysis of an ED in a large medical center in Israel

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258169
Author(s):  
Daniel Trotzky ◽  
Liron Posner ◽  
Jonathan Mosery ◽  
Aya Cohen ◽  
Shiran Avisar ◽  
...  
Keyword(s):  
Large Scale ◽  
Medical Center ◽  
Patient Flow ◽  
Primary Objective ◽  
Control Group ◽  
Minimal Impact ◽  
Notification System ◽  
Patient Morbidity ◽  
Improve Patient

Introduction Congestion in emergency departments [ED] is a significant challenge worldwide. Any delay in the timely and immediate medical care provided in the ED can affect patient morbidity and mortality. Our research analyzed the use of an innovative platform to improve patient navigation in the ED, as well as provide updated information about their care. Our hope is that this can improve ED efficiency and improve overall patient care. Objective The primary objective of our study was to determine whether the use of an automatic push notification system can shorten ‘length of stay’ (LOS) in the ED, improve patient flow, and decrease ED patient load. Methods This was a prospective cohort study utilizing data extrapolated from the electronic medical records of 2972 patients who visited the walk-in ED of a large-scale central hospital in Israel from January 17, 2021 to March 15, 2021. During this period, the automatic push text notification system was activated on a week-on week-off basis. We compared data from our experimental group with the control group. Results The results of this study indicate that the use of an automatic push notification system had a minimal impact on specific parameters of ED patient flow. Apart from a few significant reductions of specific timed-intervals during patients’ ED visit, the majority of results were not statistically significant. Conclusion This study concluded that the anticipated benefits of a push text notification system in the ED do not, at this stage, justify the system’s additional cost. We recommend a follow-up study to further investigate other possible benefits.

scholarly journals 194 Referral of Paediatric Fractures from The Emergency Department to Virtual Fracture Clinic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Effiom
Keyword(s):  
Emergency Department ◽  
Cost Effective ◽  
District General Hospital ◽  
National Guidelines ◽  
Fracture Clinic ◽  
The United Kingdom ◽  
Retrospective Audit ◽  
National Guidance ◽  
Fracture Diagnosis ◽  
Virtual Fracture Clinic

Abstract Introduction Virtual Fracture clinics (VFCs) are an alternative to the traditional fracture clinic. Recent evidence reports them to be safe, cost-effective, and efficient model without significant compromise to patient care. Aim This audit aims to assess VFC referrals from the paediatric emergency department (ED) and ensure the appropriateness of these referrals. Method This was a retrospective audit done at a large district general hospital in the United Kingdom (UK). We included patients under 18 years old presented to the emergency department with suspected or confirmed fractures and referred to virtual fracture clinics within a period of one month. The performance was measured against both local and national guidance (NICE & BOAST 7). Results Thirty patients were eligible. Thirty-three per cent of patients were appropriately referred to the VFC and ’seen’ within 72 hours. Comparing those referred 63.3% were appropriate, with inappropriate referrals mainly due to false-positive fracture diagnosis or fractures safe to be discharged home. Only 67.8% per cent of patients were managed correctly as per suspected or confirmed diagnosis with regards to fixation (i.e., splint). Conclusions The target of 100% compliance has failed. Fractures deemed safe to be discharged home from the ED are being repeated referred, radiographic interpretations often over-diagnose, and management within the department in sub-optimal. Recommendations include improving junior radiographic interpretation skills and awareness of the local and national guidelines, with another audit cycle to assess for improvement.

scholarly journals A service evaluation of e-triage in the osteoporosis outpatient clinic—an effective tool to improve patient access?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
John R. Lindsay ◽  
G. Lawrenson ◽  
S. English
Keyword(s):  
Patient Flow ◽  
Outpatient Service ◽  
Service Evaluation ◽  
Bisphosphonate Therapy ◽  
Patient Access ◽  
Specialist Service ◽  
Face To Face ◽  
Referral Management ◽  
Specialist Services ◽  
Improve Patient

Abstract Summary We introduced an electronic triage system into our osteoporosis service to actively manage referral demand in a busy outpatient service. Our study demonstrated the effectiveness of e-triage in supporting alternative management pathways, through use of virtual advice and direct to investigation services, to improve patient access. Purpose Osteoporosis referrals are increasing with awareness of the potential for prevention of fragility fracture and with complex decision making around management with long-term bisphosphonate therapy. We examined whether active triage of referrals might improve referral management processes and patient access to osteoporosis services. Methods We implemented electronic triage (e-triage) of referrals to our osteoporosis service using the Northern Ireland electronic health care record. This included the option of ‘advice only’, direct to investigation with DXA or face-to-face appointments at the consultant-led complex osteoporosis service. We anticipated that there was scope to manage patient flow direct to investigation, or to provide referring clinicians with clinical advice without the need for a face-to-face assessment, at the consultant-led specialist service. Results We reviewed e-triage outcomes of 809 referrals (692 F; 117 M) to osteoporosis specialist services (mean age 65 ± 16.5 years) over a 12-month period. There was a high degree of agreement for the triage category between the referring clinician and specialist services (741/809). 73.3% attended a face-to-face appointment at the consultant-led clinic, while active triage enabled direct to investigation (18.4%) or discharge (8.3%) in the remainder. The mean time between receipt of an electronic referral and e-triage was 3 days over the 12-month period as compared with 2.1 days (median 1.1 days) when annual leave periods were excluded. Conclusion E-triage supports effective referral management in a busy osteoporosis service. Efficiency is limited by reliance on a sole clinician and 5 day working at present. There is scope to further improve systems access through multidisciplinary team working, virtual clinics and future information technology developments.

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