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

Abstract

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.

The effects of a Virtual Fracture Care review protocol on secondary healthcare utilization in trauma patients requiring non operative treatment: a retrospective cohort study

“…Both our results and previous literature show that patients treated through VFC were less likely to reattend the ED compared to pre-VFC (11,37). However, previous studies mainly focused on the Direct Discharge protocols, only including non-operative management of simple and stable injuries Our study extends this result to patients with more complex injuries requiring hospital follow-up treatment.…”

“…However, these mostly focused on the initial treatment phase and the referral of patients to the most appropriate caregiver at the start of the treatment process. (11,14,24,25) Our results complement these studies and show that the VFC review protocol can improve e ciency of hospital follow-up treatment.…”

“…This retrospective cohort study was conducted at an urban level 2 trauma centre and teaching hospital in the Netherlands. At our institution, a VFC review protocol was introduced in April 2020 and became standard care in January 2021 (11). This protocol included all Dutch or English-speaking orthopedic trauma patients of at least one year of age, who were not acutely admitted to the hospital ward within 24 hours of presentation but required subsequent hospital treatment (Fig.…”

“…(6) As the strain on healthcare resources is increasing, addressing these issues in non-operative management may be essential in sustaining high-quality orthopedic trauma care. (7) The Virtual Fracture Care (VFC) model has emerged as a reorganizational solution for non-operative management musculoskeletal extremity injuries, adopted by various countries in several variations (8)(9)(10)(11)(12). Typically, the VFC model comprises two components: 1) a Direct Discharge protocol facilitating the direct discharge of patients with uncomplicated and stable injuries from the ED, and 2) a VFC review protocol, referring patients in need of further treatment to the most suitable healthcare professional.…”

Consultant‐led care: The new expectation

“…This was also pioneered by the frequently stretched NHS with virtual fracture clinics (VFC) demonstrating not only economic advantages but also increased patient satisfaction. The Royal Melbourne Hospital (RMH) VFC experience started well before the pandemic and is summarised by Cavka et al 8 After receiving funding from Better Care Victoria Innovation, the RMH implemented a consultant‐led referral review (with strict exclusion criteria) deciding whether patients needed physical outpatient attendance or VFC. The groups demonstrates that with consultant‐led triage of emergency department (ED) referrals, 56% went to traditional outpatient clinics, 42% were directed to VFC, 1.6% to other departments and 0.05% required surgical intervention.…”