Article Title

Virtual fracture clinic pilot in an orthopaedic tertiary hospital setting: Patient characteristics, clinical contact metrics and operational challenges

Abstract

Introduction: Virtual fracture Clinics (VFC) are established in the United Kingdom as a cost-effective conservative management pathway for patients with uncomplicated fractures. In May 2020, we established a VFC at our orthopaedic service, guided by the model from Brighton and Sussex NHS Trust. In this paper we explore patient demographics, clinic contact metrics and operational challenges of the new service in the pilot phase.

Methods: Retrospective descriptive analysis of the first 8 weeks of the VFC.

Results: VFC physiotherapists presented 190 patients to supervising orthopaedic surgical registrars. Of these, 134 patients (70.5%) were triaged to the VFC and seen in the clinic within 4.9 days on average. On average, 1.5 appointments per patient and 0.29 additional radiographs per patient were required. 83% of patients were treated over the telephone. No patients returned to the emergency department, but 4% of patients telephoned seeking more information. The most common VFC fractures were of the clavicle, radial head, fibula, fifth metatarsal and toes. About one third (31%) of patients were children. We identified no adverse events related to the operation of the clinic.

Discussion: There are some emerging differences between Australian Virtual Fracture Clinics and the UK clinics they are modelled on. We did not have any direct discharges from ED, which significantly increases the number of appointments per patient. UK clinics aim for a first appointment in 72 hours and have consultant led triage. They also have defined scopes and agreed management plans for fractures, which are not a feature of our clinic in the pilot phase. In this first 8 weeks of operation we have explored how the UK model translates into an Australian setting, whilst ensuring patient safety and good functional outcomes. In reviewing both the patients that were suitable and those that we not, we are coming to understand the patient cohort for a VFC in an Australian tertiary hospital orthopaedic service.

Keywords

virtual facture clinics, VFC, patient demographics, clinic contact metrics, operational challenges

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