fracture clinic
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2021 ◽  
Vol 16 (4) ◽  
pp. 134-145
Author(s):  
Bonnie McRae ◽  
Nicholas Shortt ◽  
Natalie Campbell ◽  
Christopher Burton ◽  
Justin Scott ◽  
...  

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.


Physiotherapy ◽  
2021 ◽  
Vol 113 ◽  
pp. e114-e115
Author(s):  
C. Drake ◽  
K. Haendlmayer ◽  
F. Richardson ◽  
J. Duncan ◽  
K. Wright

Author(s):  
Hasanka Ratnayake ◽  
Amelia Crabtree ◽  
Peter Hunter ◽  
Seema Parikh ◽  
Brenton Tay ◽  
...  
Keyword(s):  

Author(s):  
Conor S. O’Driscoll ◽  
Andrew J. Hughes ◽  
Fergus J. McCabe ◽  
Elaine Hughes ◽  
John F. Quinlan ◽  
...  

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 ◽  
...  

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.


2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Amir Varasteh ◽  
Zuned Hakim

Abstract Background Traumatic anterior shoulder dislocation is associated with a high risk of shoulder instability, reduced functional outcome, and recurrence. We conducted an audit to assess the direct management, review in fracture clinic, and definitive imaging of patients with anterior shoulder instability in Southport and Formby Hospital. Aim To identify compliance with the 2015 BOA Traumatic anterior shoulder instability guidelines. Method Identified all patients from 01/01/2019 to 31/12/2019 who had shoulder dislocation coded for their diagnosis. We used imaging, scanned notes, and clinic letters where available to identify the clinical information. We excluded patients with a false diagnosis code, and those with non-local post codes from the analysis. Results We identified 67 patients who had an anterior dislocation. 88% of patients had x-rays in both AP and Lateral.  We identified that 8.9% of patients had pre-reduction x-rays in AP only, 11.9% had no pre-reduction x-rays, and 1.5 % had no post reduction imaging. 79% of patients were seen in clinic within 6 weeks but only 40.3% were seen by a shoulder specialist and only 43.3% had appropriate imaging. 16.4% of patients were not given fracture clinic follow up. Conclusion Although most patients were managed acutely according to the guidelines, the follow up and subsequent investigations of these patients can be improved. One method we suggest is renaming fracture clinic days from consultant names to sub-specialty clinic names. In addition, a dedicated session to review the guideline with senior orthopedic surgeons cold improve the compliance as well.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Stead ◽  
M Ashraf ◽  
S Gandham ◽  
M Khattak ◽  
C Talbot

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.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Javed ◽  
M Khan ◽  
M Foxall-Smith ◽  
A Hafez ◽  
W Mason

Abstract Aim BOAST guidelines on fracture clinics suggest a standard of care that all patients with significant injury should expect to receive in a Trauma & Orthopaedics outpatient setting in the United Kingdom. Method A prospective analysis of 358 patients presenting to fracture clinic at Gloucestershire Hospitals NHS Foundation Trust from September to November 2020. Patients completed an anonymous questionnaire based on BOAST guidelines. Results Most patients received a written management plan (82%), but only some received a leaflet (36%) and definite information about their procedure (47%). Most patients felt a leaflet (72%) and information about procedures (87%) would be useful. Patients were generally seen early or within 30 minutes of their appointment time (77%), but some waited more than 30 minutes (23%). Most patients found X-rays easily (91%) and rated staff (97%) and fracture clinic experience (93%) as very good or good. Comments included noting an efficient and friendly service, with suggestions on providing more information on waiting times and procedures to be performed. Conclusions Our study showed high patient satisfaction with fracture clinic and particularly positive feedback about staff. Areas of improvement include providing more leaflets and information about practical procedures. Following this audit, we will produce leaflets on common conditions and record videos on common procedures such as application of casts, splints and removal of k-wires or sutures, which can be accessed by patients prior to their appointment. The audit could be repeated at a regional or national level to help centres assess the level of care provided.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Effiom

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.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Townley ◽  
M Flatman ◽  
A Hoyle ◽  
G Eastwood

Abstract Aim To determine the safety and efficacy of a Virtual Fracture Clinic (VFC) in managing little metacarpal neck fractures. Method Retrospective review of consecutive little MC neck fractures presenting to the ED June-December 2020 and subsequently referred on to VFC. Patient demographics and clinic outcomes were reviewed using electronic patient records and radiographs. Results Fifty patients were identified (Male:Female 37:13; mean age 26 years, range 3-89 years). Of these, 41/50 were discharged directly following VFC advice, with no adverse event. The remaining 9/50 had a face-to-face Fracture Clinic review due to safeguarding concerns (2), concurrent neck of fourth MC fracture (2), concerns regarding fracture pattern (4), and an unclear indication (1). These 9/50 were discharged after single review, with no adverse events to date. Conclusions Our data suggest that VFC review of patients with little MC neck fractures is a safe and feasible means of patient care which has the potential to reduce the requirement of face-to-face patient contact during the Covid-19 pandemic and reduce fracture clinic attendance. We suggest the routine incorporation of a Virtual Fracture Clinic for these hand injuries. Further work is needed to formally investigate associated patient satisfaction and the application of this approach to other trauma presentations.


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