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

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

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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

British Journal of Surgery ◽

10.1093/bjs/znab135.027 ◽

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.

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

Mesentery and Peritoneum ◽

10.21037/map-21-ab066 ◽

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

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Response to; Letter to the Editor Re: Standardised virtual fracture clinic management of radiographically stable Weber B ankle fractures is safe, cost effective and reproducible (April 2017)

Injury ◽

10.1016/j.injury.2018.01.016 ◽

2018 ◽

Vol 49 (3) ◽

pp. 737

Author(s):

S.F. Bellringer ◽

K. Brogan ◽

L. Cassidy ◽

J. Gibbs

Keyword(s):

Cost Effective ◽

Ankle Fractures ◽

Fracture Clinic ◽

Clinic Management ◽

Letter To The Editor ◽

Virtual Fracture Clinic

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

British Journal of Surgery ◽

10.1093/bjs/znab259.983 ◽

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.

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

Mesentery and Peritoneum ◽

10.21037/map.2020.ab154 ◽

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

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

British Journal of Surgery ◽

10.1093/bjs/znab259.016 ◽

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.

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