Electronic referrals for virtual fracture clinic service using the National Integrated Medical Imaging System (NIMIS)

Breathnach, Oisin; O'Reilly, Marc; Morrissey, Keith; Conlon, Breda; Sheehan, Eoin

doi:10.1007/s11845-018-1901-3

Cited by 21 publications

(18 citation statements)

References 17 publications

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“…Ten studies (38%) compared DD to routine care [8][9][10][11][12][13][14][15][16][17], whereas 16 (62%) studies did not have a control cohort [1,2,[18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Twenty-four studies (92%) were conducted in the UK and two in New Zealand (8%) [25,26].…”

Section: Study Characteristicsmentioning

confidence: 99%

Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature

Geerdink

Verbist

Dongen

et al. 2021

Eur J Trauma Emerg Surg

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Purpose There is growing evidence that patients with certain simple stable musculoskeletal injuries can be discharged directly from the Emergency Department (ED), without compromising patient outcome and experience. This study aims to review the literature on the effects of direct discharge (DD) of simple stable musculoskeletal injuries, regarding healthcare utilization, costs, patient outcome and experience. Methods A systematic review was performed in Medline, Embase, CINAHL, Cochrane Library and Web of Science using PRISMA guidelines. Comparative and non-comparative studies on DD of simple stable musculoskeletal injuries from the ED in an adult/paediatric/mixed population were included if reporting ≥ 1 of: (1) logistic outcomes: DD rate (proportion of patients discharged directly); number of follow-up appointments; DD return rate; (2) costs; (3) patient outcomes/experiences: functional outcome; treatment satisfaction; adverse outcomes; other. Results Twenty-six studies were included (92% conducted in the UK). Seven studies (27%) assessed functional outcome, nine (35%) treatment satisfaction, and ten (38%) adverse outcomes. A large proportion of studies defined DD eligibility criteria as injuries being minor/simple/stable, without further detail. ED DD rate was 26.7–59.5%. Mean number of follow-up appointments was 1.00–2.08 pre-DD, vs. 0.00–0.33 post-DD. Return rate was 0.0–19.4%. Costs per patient were reduced by €69–€210 (ranging from − 38.0 to − 96.6%) post-DD. Functional outcome and treatment satisfaction levels were ‘equal’ or ‘better’ (comparative studies), and ‘high’ (non-comparative studies), post-DD. Adverse outcomes were low and comparable. Conclusions This systematic review supports the idea that DD of simple stable musculoskeletal injuries from the ED provides an opportunity to reduce healthcare utilization and costs without compromising patient outcomes/experiences. To improve comparability and facilitate implementation/external validation of DD, future studies should provide detailed DD eligibility criteria, and use a standard set of outcomes. Systematic review registration number: 120779, date of first registration: 12/02/2019.

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Section: Study Characteristicsmentioning

confidence: 99%

Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature

Geerdink

Verbist

Dongen

et al. 2021

Eur J Trauma Emerg Surg

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“…A national roll-out of the TAC service would require little investment as the necessary infrastructure of digital imaging is already in place and not being utilised to it's maximum potential in terms of electronic referral capacity and clinical conferencing. [21,22] Furthermore the necessary collaterals of allied health professionals and administrative staff would only require a reorganisation or redeployment of services in most units.…”

Section: Discussionmentioning

confidence: 99%

A national virtual fracture clinic service: A more tactful approach

Reilly¹

2020

IJOTSS

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Introduction: The redesign and reconfiguration of the traditional "face to face" fracture clinic model towards virtual assessment and management of patients has been shown to be safe, cost-effective and associated with high patient satisfaction and patient reported outcome rates. The purpose of this study was to look at the potential financial implications of introducing a national virtual fracture clinic service in Ireland. Methods: A combination of established costings for a virtual fracture clinic pathway at our institution and current available public data was utilised to create a national projection. Results: The introduction of a national TAC service could lead to areduction of 31.5% of patients attending traditional "face to face" fracture clinic appointments with a further 35% of this cohort being discharged directly representing an overall projected cost saving per annum in excess of €3.3 million. Conclusion: The introduction of a national TAC service would promote patient empowerment without comprising clinical care and could provide significant cost savings and financial benefits for the Irish Public Health System without the need for substantial investment.

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“…Patient satisfaction for recovery using a VFC model of care varies in the literature from 91–97%, 19 , 20 , 46 from studies including 138–2704 patients. Satisfaction with the information provided varied from 86% to 95%.…”

Section: Patient Satisfactionmentioning

confidence: 99%

“… 21 Breathnach et al noted that 28% of the participants would have preferred a face-to-face model and two participants returned to their GP/ED for further pain relief and advice. 20 In self-care protocols for injuries, Brooksbank et al noted that seven of the mallet injuries studied were reviewed by the general practitioner or other clinicians during their treatment. 41 In the pioneering unit for the virtual model, there are currently no medicolegal cases reported, after having managed 30,000 patients.…”

Section: Vfc Limitationsmentioning

confidence: 99%

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

et al. 2020

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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

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Electronic referrals for virtual fracture clinic service using the National Integrated Medical Imaging System (NIMIS)

Cited by 21 publications

References 17 publications

Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature

Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature

A national virtual fracture clinic service: A more tactful approach

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

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