Introducing a Virtual Fracture Clinic Increases Efficiency and Reduces Costs in Torus Fracture Management

Seewoonarain, Sheena; Babu, Satish; Sangoi, Dhrumin; Avasthi, Adhish; Ricketts, David

doi:10.1097/pq9.0000000000000202

Cited by 16 publications

(42 citation statements)

References 8 publications

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“…The study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethical committee of OLVG Hospital (ref no 18.071) and by its board of directors.…”

Section: Competing Interests None Declaredmentioning

confidence: 99%

“…7 DD has been studied for several SSIs within the United Kingdom (UK), including, among others, Mason type 1 radial head fractures, 8 9 fifth metacarpal neck fractures, 8 10 11 base of fifth metatarsal fractures, 8 12 13 buckle-type fractures of the distal radius, and pediatric clavicle fractures. [14][15][16][17][18] These studies indicate that DD reduces follow-up appointments, imaging, no-shows, and costs without compromising outcome and experience. To our knowledge, however, no studies have been performed outside the UK, whereas it is important to externally validate and evaluate effects in other settings, such as a different country.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Direct discharge from the emergency department of simple stable injuries: a propensity score-adjusted non-inferiority trial

Geerdink

Augustinus

Groen

et al. 2021

Trauma Surg Acute Care Open

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BackgroundRecent studies suggest a large proportion of musculoskeletal injuries are simple stable injuries (SSIs). The aim of this study was to evaluate whether direct discharge (DD) from the emergency department (ED) of SSIs is non-inferior to ‘traditional care’ regarding treatment satisfaction and functional outcome, and to compare other patient-reported outcomes (PROMs), patient-reported experiences (PREMs), resource utilization, and adverse outcomes before and after DD.MethodsThis trial compared outcomes for 11 SSIs 6 months before and after the implementation of DD protocols. Pre-DD, patients were treated according to local protocols. Post-DD, patients were discharged directly using removable orthoses, discharge leaflets, smartphone application, and telephone helpline. Participants received a 3-month postinjury PROM/PREM survey to assess treatment satisfaction (Visual Analog Scale, VAS), pain (VAS), functional outcome (four validated questionnaires), and health-related quality of life (HR-QoL; EuroQol-5D). Resource utilization included general practitioner (GP) visit (yes/no), physiotherapist visit (yes/no), return to work/school/sports (days), work/school absenteeism to visit hospital (yes/no), number of hospital visits, and follow-up X-rays. Other outcomes included missed injuries (additionally to SSI) and adverse outcomes (delayed union, non-union). Between-group differences were assessed using propensity score-adjusted regression analyses. Non-inferiority was assessed for satisfaction and functional outcome using predefined margins.Results348 (pre-DD) and 371 (post-DD) patients participated; 144 (41.4%) and 153 (41.2%) patients completed the survey. Satisfaction and functional outcome post-DD were non-inferior to traditional care. Mean satisfaction was 8.13 pre-DD and 7.95 post-DD (mean difference: −0.16, p=0.408). Pain, HR-QoL, GP/physiotherapist visits, and return to work/school/sports were comparable before and after DD. Work absenteeism was higher pre-DD (OR 0.110, p<0.001), as well as school absenteeism (OR 0.084, p<0.001). Post-DD, the mean number of hospital visits and X-rays reduced: −1.68 (p<0.001) and −0.26 (p<0.001). Missed injuries occurred once pre-DD versus twice post-DD. There were no adverse outcomes.DiscussionThe results of this study confirm several SSIs can be discharged directly from the ED without compromising patient outcome/experience. Future injury-specific trials are needed to conclusively assess non-inferiority of DD.Level of evidenceII.

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“…The study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethical committee of OLVG Hospital (ref no 18.071) and by its board of directors.…”

Section: Competing Interests None Declaredmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Direct discharge from the emergency department of simple stable injuries: a propensity score-adjusted non-inferiority trial

Geerdink

Augustinus

Groen

et al. 2021

Trauma Surg Acute Care Open

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“…63 A recent retrospective study also demonstrated increased efficiency and cost reduction in managing these injuries in a VFC setting. 21 …”

Section: Paediatric Injuriesmentioning

confidence: 99%

How useful are virtual fracture clinics?

et al. 2020

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Background Due to the overwhelming demand for trauma services, resulting from increasing emergency department attendances over the past decade, virtual fracture clinics (VFCs) have become the fashion to keep up with the demand and help comply with the BOA Standards for Trauma and Orthopaedics (BOAST) guidelines. In this article, we perform a systematic review asking, “How useful are VFCs?”, and what injuries and conditions can be treated safely and effectively, to help decrease patient face to face consultations. Our primary outcomes were patient satisfaction, clinical efficiency and cost analysis, and clinical outcomes. Methods We performed a systematic literature search of all papers pertaining to VFCs, using the search engines PubMed, MEDLINE, and the Cochrane Database, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Searches were carried out and screened by two authors, with final study eligibility confirmed by the senior author. Results In total, 21 records were relevant to our research question. Six orthopaedic injuries were identified as suitable for VFC review, with a further four discussed in detail. A reduction of face to face appointments of up to 50% was reported with greater compliance to BOAST guidelines (46.4%) and cost saving (up to £212,000). Conclusions This systematic review demonstrates that the VFC model can help deliver a safe, more cost-effective, and more efficient arm of the trauma service to patients. Cite this article: Bone Joint Open 2020;1-11:683–690.

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“…However, previous studies on VFCs have shown their effectiveness for the management of a number of orthopaedic injuries not requiring surgical intervention. These include patients with simple radial head fractures, little finger metacarpal fractures, fifth metatarsal fractures, and buckle fractures in children [ 20 , 21 ]. Bhattacharya et al found that patients with undisplaced clavicle fractures can be discharged after a single virtual consultation with good patient outcomes and satisfaction [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

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

Sharma¹,

Butt²,

Ajayi³

et al. 2021

Cureus

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Introducing a Virtual Fracture Clinic Increases Efficiency and Reduces Costs in Torus Fracture Management

Cited by 16 publications

References 8 publications

Direct discharge from the emergency department of simple stable injuries: a propensity score-adjusted non-inferiority trial

Direct discharge from the emergency department of simple stable injuries: a propensity score-adjusted non-inferiority trial

How useful are virtual fracture clinics?

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

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