How useful are virtual fracture clinics?

Khan, Sheeba; Asokan, Ajay; Handford, C. Robertson; Logan, Peter; Moores, Thomas

doi:10.1302/2633-1462.111.bjo-2020-0107.r1

Cited by 23 publications

(32 citation statements)

References 53 publications

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“…This will allow physicians to spend more time on patients with more complex injuries, teaching, training, or improving standards of care. Frequently, studies, including several systematic reviews performed recently [32][33][34], report on the effects of the VFC model as a whole. This model includes both DD of simple stable musculoskeletal injuries, as well as a daily VFC review, consequently including more complex injuries that require follow-up (Fig.…”

Section: Summary Of Evidencementioning

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: Summary Of Evidencementioning

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 recent systematic review confirmed the safety, efficacy and cost-effectiveness of the virtual fracture clinic model within the broader provision of trauma services. 19 However, it was notable that this review of 21 articles contained a single series of 253 children managed by a dedicated paediatric virtual fracture clinic pathway. 6 Other reports describe results from isolated protocols to manage individual childhood injuries 20 or describe an iterative processes to implement a virtual fracture clinic within the setting of district general hospital.…”

Section: Discussionmentioning

confidence: 99%

One and done? Outcomes from 3961 patients managed via a virtual fracture clinic pathway for paediatric fractures

Kennedy

Blackburn

Barrett

et al. 2021

Journal of Children's Orthopaedics

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Purpose The aim of this paper is to describe our experience with a virtual fracture management pathway in the setting of a paediatric trauma service. Methods All patients referred to the virtual fracture clinic service from the Paediatric Emergency Department (PED) were prospectively collected. Outcome data of interest (patients discharged, referred for urgent operative treatment, referred back to emergency department for further evaluation, referred for face-to-face clinical assessment and all patients who re-presented on an unplanned basis for further management of the index injury) were compiled and collated. Cost analysis was performed using established costing for a virtual fracture clinic within the Irish Healthcare System. Results There were a total of 3961 patients referred to the virtual fracture clinic from the PED. Of these, 70% (n = 2776) were discharged. In all, 26% (n = 1033) were referred to a face-to-face appointment. Of discharged patients, 7.5% (n = 207) required an unplanned face-to-face evaluation. A total of 0.1% (n = 3) subsequently required operative treatment relating to their index injury. Implementation of the virtual fracture clinic model generated calculated savings of €254 120. Conclusion This prospective evaluation has demonstrated that a virtual fracture clinic pathway for minor paediatric trauma is safe, effective and brings significant cost savings. Level of Evidence II

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“…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. 25 However, a high index of suspicion and expertise may be required in the management of other types of injuries with lower prevalence but higher morbidity where radiographs may be misinterpreted, to avoid adverse outcomes and complications.…”

Section: Discussionmentioning

confidence: 99%

“… 25 However, a high index of suspicion and expertise may be required in the management of other types of injuries with lower prevalence but higher morbidity where radiographs may be misinterpreted, to avoid adverse outcomes and complications. 12 , 15 …”

Section: Discussionmentioning

confidence: 99%

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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

Downie

Makaram

et al. 2021

Bone & Joint Open

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Aims Virtual fracture clinics (VFCs) are advocated by recent British Orthopaedic Association Standards for Trauma and Orthopaedics (BOASTs) to efficiently manage injuries during the COVID-19 pandemic. The primary aim of this national study is to assess the impact of these standards on patient satisfaction and clinical outcome amid the pandemic. The secondary aims are to determine the impact of the pandemic on the demographic details of injuries presenting to the VFC, and to compare outcomes and satisfaction when the BOAST guidelines were first introduced with a subsequent period when local practice would be familiar with these guidelines. Methods This is a national cross-sectional cohort study comprising centres with VFC services across the UK. All consecutive adult patients assessed in VFC in a two-week period pre-lockdown (6 May 2019 to 19 May 2019) and in the same two-week period at the peak of the first lockdown (4 May 2020 to 17 May 2020), and a randomly selected sample during the ‘second wave’ (October 2020) will be eligible for the study. Data comprising local VFC practice, patient and injury characteristics, unplanned re-attendances, and complications will be collected by local investigators for all time periods. A telephone questionnaire will be used to determine patient satisfaction and patient-reported outcomes for patients who were discharged following VFC assessment without face-to-face consultation. Ethics and dissemination The study results will identify changes in case-mix and numbers of patients managed through VFCs and whether this is safe and associated with patient satisfaction. These data will provide key information for future expert-led consensus on management of trauma injuries through the VFC. The protocol will be disseminated through conferences and peer-reviewed publication. This protocol has been reviewed by the South East Scotland Research Ethics Service and is classified as a multicentre audit. Cite this article: Bone Jt Open 2021;2(3):211–215.

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How useful are virtual fracture clinics?

Cited by 23 publications

References 53 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

One and done? Outcomes from 3961 patients managed via a virtual fracture clinic pathway for paediatric fractures

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

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