The Narrative Review of Published Evidence on Cost Analysis and Sustainability of the Virtual Fracture Clinic Model: A Report Based Study

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.

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

Mesentery and Peritoneum ◽

10.21037/map.2020.ab261 ◽

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

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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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Narrative review of published evidence

Research and Review Insights ◽

10.15761/rri.1000156 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Gitana Diana Stukaite

Keyword(s):

Narrative Review ◽

Published Evidence

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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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Searching for the Fetal Alcohol Behavioral Phenotype

Global Pediatric Health ◽

10.1177/2333794x20941337 ◽

2020 ◽

Vol 7 ◽

pp. 2333794X2094133

Author(s):

Gideon Koren ◽

Asher Ornoy

Keyword(s):

High Sensitivity ◽

Behavioral Phenotype ◽

Narrative Review ◽

Screening Tools ◽

Fetal Alcohol ◽

Predictive Values ◽

Published Evidence ◽

Sensitivity Specificity ◽

Fetal Alcohol Spectrum

This narrative review presents the emerging published evidence on the existence of a phenotypic behavior in children with fetal alcohol spectrum behavior. Such a phenotype, exhibiting high sensitivity, specificity, and predictive values, may assist clinicians and families in identifying children who often miss some of the information needed for full diagnosis, but who may benefit from these screening tools in mobilizing help to these youngsters and their families.

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