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

Abstract

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.

How safe and effective are paediatric virtual fracture clinics? A systematic review

“…The remaining study by Aboelmagd et al assessed the use of a VFC for suspected scaphoid fractures ( 28 ) which often have minimal radiological evidence on diagnosis but have a high morbidity if missed due to the risk of avascular necrosis ( 31 ). The sex distribution was close to evenly split with a slight male predominance ( 25 – 28 ).…”

“…Five of the studies reported on the time between initial presentation and review in the VFC and all of these were within 72 h, indicating high compliance with the BOAST 7 guidelines ( 25 , 27 – 30 ).…”

“…Two studies assessed parent or guardian satisfaction with the VFC pathway ( 25 , 30 ). The reported parental satisfaction was high with 96.9% and 100% of parents strongly agreeing or agreeing that they were satisfied with their child's recovery.…”

“…The rate of unexpected re-presentations after VFC discharge remained comparable to the rates of unplanned readmissions in orthopaedic and paediatric trauma specialties. The rates of unplanned re-presentations in the review were 0%, 2.2%, 2.6%, 3% and 6.6% respectively ( 25 – 28 , 30 ). Bernatz et al found the unplanned readmission rate across orthopaedic subspecialties was 3% ( 34 ), while Wheeler et al found a 1.7% unplanned readmission rate in paediatric trauma patients ( 35 ).…”

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

“…(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.…”