Infographic: Trauma Triage Clinic reduces unnecessary fracture clinic attendances and costs with comparable clinical outcomes

Mackenzie, Samuel P.; Carter, T H; Jefferies, J G; Wilby, J B J; Hall, Peter; Duckworth, Andrew D.; Keating, JF; White, T O

doi:10.1302/0301-620x.100b7.bjj-2018-0623

Cited by 7 publications

(10 citation statements)

References 4 publications

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“…Similar findings have been reported by other institutions for a range of orthopaedic conditions with VFC direct discharge rates as high as 75% 10–16 . Concomitant findings of improvement in outpatient clinic access and utilization, cost savings and enhanced patient satisfaction have also been described 17–21 …”

Section: Introductionsupporting

confidence: 84%

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

Cavka

Cross

Montvida

et al. 2021

ANZ Journal of Surgery

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Background In Australian health care, the consistent rise in demand for orthopaedic outpatient clinic services is creating marked challenges in the provision of quality care. This study investigates the efficacy and safety of a virtual fracture clinic (VFC) as an alternative model of care for the management of acute injuries and musculoskeletal conditions in the Australian public hospital setting. Methods A retrospective cohort study of consecutive emergency department (ED) referrals to the Department of Orthopaedic Surgery was conducted comparing outcomes prior to (November 2015–February 2017) and after (March 2017–June 2018) implementation of a VFC. The primary outcome measures assessed were the proportion of referrals virtually discharged and unplanned 30‐day ED re‐attendance rates. Results A total of 737 (36.4%) referrals managed by the VFC were discharged without requiring orthopaedic outpatient clinic attendance. The rate of unplanned ED re‐attendances was 5.2% post‐VFC implementation compared to 6.5% at baseline (P = 0.01). VFC implementation was also associated with reductions in the average number of orthopaedic outpatient clinic attendances per referral (1.1 versus 1.7, P < 0.01) and the number of referrals lost to follow‐up (7.2% versus 14.7%, P < 0.01). In addition, patient wait times for first contact by the orthopaedic team were significantly reduced from a median of 7 (IQR 5, 9) days to 2 (IQR 1, 3) days post‐intervention (P < 0.01). No complications or adverse events were reported. Conclusion This study demonstrates that a VFC is applicable to the Australian healthcare system, and can lead to effective and safe provision of orthopaedic outpatient care.

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Section: Introductionsupporting

confidence: 84%

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

Cavka

Cross

Montvida

et al. 2021

ANZ Journal of Surgery

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“…This satisfaction rate is in keeping with but also above the rates quoted by other international studies from centres with well-established virtual fracture clinic pathways. 2,4,5,14,15 Adult patient functional outcomes were further assessed by limb specific PROMs, the QuickDASH score for upper limb injuries and the LEFS score for lower limb injuries, with the addition of the EQ-5D-5L questionnaire to capture health-related quality of life. In this study the median QuickDASH score was 0 (n = 42), where 0 is no disability and 100 is the most disability, and with a normative data median of 1 (Age matched for combined male and female values reported by Aasheim et al) for the QuickDASH score, this further corroborates that the virtual management of certain upper limb fracture types is safe and correlates with excellent PROM scores.…”

Section: Discussionmentioning

confidence: 99%

“…The concept of virtual fracture clinics (VFC) has been adopted by several institutions across the United Kingdom and Ireland with a growing amount of evidence showing that for specific injury types, in both paediatric and adult populations, it is safe, cost-effective and associated with good patient reported outcome measures (PROMs) and satisfaction rates. [1][2][3][4][5][6] Our institution was the first centre to introduce a VFC model, referred to as the Trauma Assessment Clinic (TAC), within the Irish public health system in 2016 and what was initially a pilot project is now a fully established and integrated care pathway at the unit. The TAC model is a variation of the VFC template, pioneered at Glasgow Royal Infirmary, with one of the main differentiating factors being that the direct discharge of patients with stable/low operative risk or TAC appropriate fractures (See Table 1 -TAC appropriate fracture types) not occurring at the ED stage of presentation but instead taking place following TAC review.…”

Section: Introductionmentioning

confidence: 99%

Trauma Assessment Clinic: A virtual fracture clinic model that delivers on its PROMise!

et al. 2022

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Background The use of virtual fracture clinics across the United Kingdom and Ireland is growing and have been shown in an increasing number of studies to be safe, cost-effective and associated with good functional outcomes and patient satisfaction rates for certain fracture types. Initially pioneered at Glasgow Royal Infirmary, many centres have adopted similar templates, or variations of, and the overall aim of this study was to assess functional outcomes and injury recovery satisfaction rates of patients discharged directly following review in a specific virtual fracture clinic model known as the Trauma Assessment Clinic (TAC). Methods A prospective observational study was carried out of paediatric (aged <17 years) and adult (aged >17 years) patients, with the five most commonly observed fracture types, who were discharged directly following review at the TAC in a single hospital centre over a 12 month period from January to December 2018. Primary and secondary outcomes were assessed via telephone administered questionnaires and patient reported outcome measures (PROMs). Results A total of 198 patients were included in the study (n = 98 paediatric and n = 100 adult). Overall, 192 (97%) patients or parents/guardians of patients stated that they either strongly agreed (n = 148, 74.9%) or agreed (n = 44, 22.1%) that they were satisfied with their own or their child's recovery from their injury at a median follow-up of 9 months post direct discharge from the TAC. Adult patients had an EQ-5D-5L index median value of 1 (range 0-1), an EQ-VAS median of 87 (range 0-100), a QuickDASH median score of 0 (range 0-100) and a median LEFS of 80 (range 0–80). Conclusion The virtual management of trauma patients via the TAC model is a safe and patient-centred approach to treating certain injuries and fracture patterns. This study reports excellent patient reported outcome measures and patient injury recovery satisfaction rates. The use of current available technology in tandem with up-to-date best clinical practice and guidelines play a central role in this novel care pathway.

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“…The virtual clinic model is increasingly being adopted by various medical and surgical specialities and has revealed both a safe and cost-effective patient pathway associated with high patient satisfaction rates and patient reported outcomes. [1][2][3][4][5][6][7][8] The redesign and reconfiguration of the traditional "face to face" fracture clinic model towards virtual assessment and management of patients has been shown in some studies to equate to a saving of almost 40% in direct costs. [8][9][10][11] While indirect costs are more difficult to accurately determine, some stud-ies have cited approximately €80 per consultation as a cost to society, because of a reduction in productivity, as well as equating to nearly half a day of school lost with regard to paediatric fracture clinic appointments.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] The redesign and reconfiguration of the traditional "face to face" fracture clinic model towards virtual assessment and management of patients has been shown in some studies to equate to a saving of almost 40% in direct costs. [8][9][10][11] While indirect costs are more difficult to accurately determine, some stud-ies have cited approximately €80 per consultation as a cost to society, because of a reduction in productivity, as well as equating to nearly half a day of school lost with regard to paediatric fracture clinic appointments. [12][13][14] A virtual fracture clinic service, known as the Trauma Assessment Clinic or TAC, was introduced at the Midlands Regional Hospital Tullamore (MRHT) in 2016 and was the first unit to introduce this novel care pathway in the Irish Public Health System.…”

Section: Introductionmentioning

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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Infographic: Trauma Triage Clinic reduces unnecessary fracture clinic attendances and costs with comparable clinical outcomes

Cited by 7 publications

References 4 publications

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

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

Trauma Assessment Clinic: A virtual fracture clinic model that delivers on its PROMise!

A national virtual fracture clinic service: A more tactful approach

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