scholarly journals Virtual Fracture Clinic: A pandemic-ready tool for improving the efficiency of fracture clinic

2021 ◽  
Vol 16 (4) ◽  
pp. 134-145
Author(s):  
Bonnie McRae ◽  
Nicholas Shortt ◽  
Natalie Campbell ◽  
Christopher Burton ◽  
Justin Scott ◽  
...  
Keyword(s):  
Close Contact ◽  
District General Hospital ◽  
Urban District ◽  
Minimal Impact ◽  
Fracture Clinic ◽  
Global Pandemic ◽  
Complex Patients ◽  
Number Of Patients ◽  
Minor Injuries ◽  
Virtual Fracture Clinic

Background: The traditional model of care of the Orthopaedic Fracture Clinic (OFC) is labour intensive, expensive, has poor satisfaction rates, and often has minimal impact on management and outcomes of patients with minor injuries. Our aim was to implement a Virtual Fracture Clinic (VFC) for the management of minor injuries that is safe, reduces OFC clinic workload and reduces the OFC failure to attend (FTA) rate. Methods: This study was a retrospective longitudinal audit of OFC workload before (January 2012 -February 2017) and after (March 2017 – December 2019) implementation of the VFC. It was performed in an urban district general hospital in South East Queensland, Australia. The primary outcome measures included attendances per timepoint (month). Results: Overall, we observed a significant reduction in total number of patients from 1,055 (IQR 104.5) to 831 (IQR: 103) per month) coming through the OFC following the introduction of the VFC (F = 21.9; df=1; p <0.0001). The failure to attend rate was reduced by 44% from 271 (IQR: 127.3) to 151 (IQR: 72.8) (F=4.0; df=1; p = 0.047). Conclusion: The VFC implementation was successful in improving efficiency and reducing the current OFC workload, as well as reducing FTA rate. Reduction in clinic workload allows more time to be spent with complex patients, prevents clinic backlogs and overbooking, and crowding of waiting rooms. In the midst of a global pandemic that is spread by close contact, virtual clinics seem the way of the future to treat patients whilst minimising risk of COVID-19 spread.

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 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 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 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.

COVID-19 and nutritional deficiency: a review of existing knowledge

2021 ◽  
Vol 42 (1) ◽  
pp. 77-85
Author(s):  
Meghana Muthuvattur Pallath ◽  
Ashok Kumar Ahirwar ◽  
Satyendra Chandra Tripathi ◽  
Priyanka Asia ◽  
Apurva Sakarde ◽  
...  
Keyword(s):  
Immune Responses ◽  
Viral Infection ◽  
Close Contact ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Antibody Affinity ◽  
Global Pandemic ◽  
Underlying Diseases ◽  
Pro Inflammatory Cytokines

Abstract COVID-19 has resulted in an ongoing global pandemic, which spread largely among people who have had close contact with the infected person. The immunopathology of the SARS-CoV-2 virus includes the production of an excess amount of pro-inflammatory cytokines “a cytokine-storm”. The respiratory system (main), cardiovascular system and the gastrointestinal tract are the most affected body systems during viral infection. It has been found that most of the patients who require admission to hospital are elderly or have chronic underlying diseases. Higher cases of malnutrition and co-morbidities like diabetes mellitus and cardiovascular diseases are reported in elderly patients due to which, the immune system weakens and hence, the response to the virus is diminished in magnitude. A deficiency of micronutrients results in impaired immune responses leading to improper secretion of cytokines, alterations in secretory antibody response and antibody affinity which increases susceptibility to viral infection. The deficiency of various micronutrients in COVID-19 patient can be treated by appropriate nutritional supplements, prescribed after evaluating the patients’ nutritional status. Here we aim to highlight the role of a few particular nutrients namely Vitamin D, Vitamin C, Omega-3 fatty acids, Zinc and Magnesium along with the synergistic roles they play in enhancing immunity and thus, maintaining homeostasis.

Impacts of Social Distancing on Pedestrian Behavior and Risk Perception

2021 ◽  
Vol 65 (1) ◽  
pp. 1302-1306
Author(s):  
Kyra B. Phillips ◽  
Kelly N. Byrne ◽  
Branden S. Kolarik ◽  
Audra K. Krake ◽  
Young C. Bui ◽  
...  
Keyword(s):  
United States ◽  
Risk Perception ◽  
Perceived Risk ◽  
Close Contact ◽  
The United States ◽  
Survey Study ◽  
Pedestrian Behavior ◽  
Social Distancing ◽  
Global Pandemic ◽  
Over Time

Since COVID-19 transmission accelerated in the United States in March 2020, guidelines have recommended that individuals wear masks and limit close contact by remaining at least six feet away from others, even while outdoors. Such behavior is important to help slow the spread of the global pandemic; however, it may require pedestrians to make critical decisions about entering a roadway in order to avoid others, potentially creating hazardous situations for both themselves and for drivers. In this survey study, we found that while overall patterns of self-reported pedestrian activity remained largely consistent over time, participants indicated increased willingness to enter active roadways when encountering unmasked pedestrians since the COVID-19 pandemic began. Participants also rated the risks of encountering unmasked pedestrians as greater than those associated with entering a street, though the perceived risk of passing an unmasked pedestrian on the sidewalk decreased over time.

scholarly journals Does it Matter Whom You See?–A Fracture Clinic Audit

2006 ◽  
Vol 88 (6) ◽  
pp. 540-542 ◽  
Author(s):  
TDA Cosker ◽  
A Ghandour ◽  
T Naresh ◽  
K Visvakumar ◽  
SR Johnson
Keyword(s):  
Complex Trauma ◽  
Discharge Rate ◽  
Trauma System ◽  
Presentation Rate ◽  
Fracture Clinic ◽  
Complete Cycle ◽  
Junior Staff ◽  
Number Of Patients ◽  
The Uk

INTRODUCTION A consultant-led service for trauma in the UK has become the accepted norm. Practice in fracture clinics may vary widely between consultants and has an impact on the number of patients seen and, therefore, the time devoted to each patient. PATIENTS AND METHODS A total of 945 patients attending our unit's fracture clinics were analysed over a 6-week period, representing one complete cycle of our trauma system. RESULTS The overall discharge rate was 38% but this differed significantly between consultants. Patients re-presenting for the same complaint were evenly distributed between those discharging aggressively and those re-reviewing regularly. CONCLUSIONS Re-reviewing patients has a significant impact on the number of patients seen in future clinics and, therefore, the time that can be devoted to each patient, individual consultant workload and teaching of junior staff. Since the re-presentation rate between those discharging aggressively and those re-reviewing more frequently was the same, discharge protocols are recommended for common trauma conditions to standardise the process. Specialist clinics are recommended for more complex trauma cases.

scholarly journals Covidom, a Telesurveillance Solution for Home Monitoring Patients With COVID-19 (Preprint)

2020 ◽  
Author(s):  
Youri Yordanov ◽  
Agnes Dechartres ◽  
Xavier Lescure ◽  
Caroline Apra ◽  
Pascaline Villie ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Web Application ◽  
Large Scale ◽  
Home Monitoring ◽  
Control Center ◽  
Regional Control ◽  
Global Pandemic ◽  
Number Of Patients ◽  
Paris Area ◽  
Innovative Solution

UNSTRUCTURED In a matter of months, COVID-19 has escalated from a cluster of cases in Wuhan, China, to a global pandemic. As the number of patients with COVID-19 grew, solutions for the home monitoring of infected patients became critical. This viewpoint presents a telesurveillance solution—Covidom—deployed in the greater Paris area to monitor patients with COVID-19 in their homes. The system was rapidly developed and is being used on a large scale with more than 65,000 registered patients to date. The Covidom solution combines an easy-to-use and free web application for patients (through which patients fill out short questionnaires on their health status) with a regional control center that monitors and manages alerts (triggered by questionnaire responses) from patients whose health may be deteriorating. This innovative solution could alleviate the burden of health care professionals and systems while allowing for rapid response when patients trigger an alert.

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
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