An analysis of virtual fracture clinics in orthopaedic trauma in the UK during the coronavirus crisis

Abstract

Virtual fracture clinics (VFC) are advocated by new orthopaedic (British Orthopaedic Association) and National Health Service (NHS) guidelines in the United Kingdom. We discuss benefits and limitations, reviewing the literature, as well as recommendations on introducing a VFC service during the coronavirus pandemic and into the future. A narrative review identifying current literature on virtual fracture clinic outcomes when compared to traditional model fracture clinics in the UK. We identify nine relevant publications related to VFC. The Glasgow model, initiated in 2011, has become the benchmark. Clinical efficiency can be improved, reducing the number of emergency department (ED) referrals seen in VFC by 15–28% and face-to-face consultations by 65%. After review in the VFC, 33–60% of patients may be discharged. Some studies have shown no negative impact on the ED; the time to discharge was not increased. Patient satisfaction ranges from 91–97% using a VFC service, and there may be cost-saving benefits annually of £67,385 to £212,705. Non-attendance may be reduced by 75% and there are educational opportunities for trainees. However, evidence is limited; 28% of patients prefer face-to-face consultations and not all have access to internet or email (72%). We propose a pathway integrating the VFC model, whilst having senior orthopaedic decision makers available in the ED, during normal working hours, to cope with the pandemic. Beyond the pandemic, evidence suggests the Glasgow model is viable for day-to-day practice. Cite this article: EFORT Open Rev 2020;5:442-448. DOI: 10.1302/2058-5241.5.200041

Retrospective cohort study evaluating the efficacy and safety of an orthopaedic consultant‐led virtual fracture clinic in an Australian level 1 trauma centre

“…Virtual fracture clinics (VFCs) have been widely implemented in the UK and Republic of Ireland as an alternative to traditional fracture clinic attendance 6 . The original model published by the Glasgow Royal Infirmary consisted of direct emergency department (ED) discharge of simple stable injuries including fifth metacarpal, radial head, metatarsal and stable ankle fractures, and VFC review of remaining conditions not requiring admission 7,8 .…”

A Hybrid Virtual Fracture Clinic is Safe and Efficacious in the COVID-19 Era: Stay at Home and Save Lives

“…A decrease in non-attendance of almost 75% was noted. They also noted that VFCs do not impede the training and education of trainees [ 19 ].…”

A multicentre national study of the effectiveness of virtual fracture clinic management of orthopaedic trauma during the COVID-19 pandemic (MAVCOV): a cross-sectional study protocol

“…A number of recent articles have described the rapid adoption and evolution of VFC services during the pandemic. 9 , 17 - 20 The general principles of the VFC model as outlined by the original centre remain the same. 2 , 9 , 12 However, there is variation in practice across the UK, including the grade of staff making management decisions, provision of verbal and written information, and local treatment protocols for specific injuries.…”

“… 9 , 17 - 20 The general principles of the VFC model as outlined by the original centre remain the same. 2 , 9 , 12 However, there is variation in practice across the UK, including the grade of staff making management decisions, provision of verbal and written information, and local treatment protocols for specific injuries. 12 Prior to the pandemic, several studies have reported good acceptability of the VFC model in their local centres in the management of specific injuries, such as fifth metacarpal fractures, 3 , 21 fifth metatarsal fractures, 3 , 22 clavicle fractures, 23 mallet finger injuries, 24 and ankle fractures.…”

“…The global outbreak of COVID-19 has precipitated the rapid development and evolution of VFCs nationally due to necessities for safe hospital distancing. 9 , 10 The shift to virtual clinics is advocated by the British Orthopaedic Association (BOA) in the recently published COVID-19 BOAST guidelines which stipulate 1) patient-initiated follow-up should be the default, with booked appointments only where this is unavoidable; and 2) follow-up appointments should be delivered by telephone or video call if at all possible. 11 The BOA has also acknowledged there will be an increased emphasis on nonoperative management and minimizing outpatient visits amid the current pandemic.…”