Trauma assessment clinic: Virtually a safe and smarter way of managing trauma care in Ireland

Reilly, Marc O’; Breathnach, Oisin; Conlon, Breda; Kiernan, Christine; Sheehan, Eoin

doi:10.1016/j.injury.2019.03.046

Cited by 44 publications

(59 citation statements)

References 50 publications

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“…[20] Any measures that promote patient empowerment but without comprising patient care should be harnessed by health managers. [15] This study reveals the potential cost savings and financial benefits of introducing a national TAC service. The projected direct cost saving of over €3.3 million does not take into account the far greater and outreaching economic and societal implications of reduced, unwarranted follow-up in the context of work days lost, school days lost and associated childcare costs.…”

Section: Discussionmentioning

confidence: 89%

“…[17] Current data from the MRHT TAC model reveal that 35% of patients reviewed in the TAC are discharged directly. [15] Therefore of the projected 17,325 patients that would be reviewed in a national TAC service 6,063 patients would be expected to be discharged directly representing a cost saving of over €1.5 million due to a reduction in unnecessary return appointments (See Figure 1). Therefore, the overall projected cost saving of introducing a national TAC service would be in excess of €3.3 million per annum (See Table 4).…”

Section: National Projectionsmentioning

confidence: 99%

“…During the corresponding period in 2014-2015 [Pre TAC] there was a total of 2,676 patients reviewed via the traditional "face to face" fracture clinic at MRHT. [15] This represents a reduction of 31.5% following the introduction of the TAC pathway (See Table 1).…”

Section: Pre and Post Tac Introduction Comparisonmentioning

confidence: 99%

“…[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. [15] In this model patients arriving to the Emergency Department (ED) with injuries that are TAC appropriate https://ijotss.com/ (simple, stable fracture patterns)are treated as per a recognised protocol. Patients are provided with information about their injury and placed in a removable splint or cast and informed that they will receive a follow up phone call from the orthopaedic team.…”

Section: Introductionmentioning

confidence: 99%

“…Within 24-72 hrs the patient's clinical notes and x-rays are reviewed by the TAC multidisciplinary team (MDT) and patients are contacted and counselled as to their planned treatment. 15 One study revealed that during the first 19 months of its introduction the TAC reviewed a total of 2,704 patients which represented a cost saving of over quarter of a million euro, when compared to the traditional "face to face" pathway, with 97% of surveyed patients stating they agreed or strongly agreed that they were satisfied with their recovery. [15] The aim of this study was to look at the potential financial implications of introducing a national virtual fracture clinic service in Ireland.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 89%

Section: National Projectionsmentioning

confidence: 99%

Section: Pre and Post Tac Introduction Comparisonmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A national virtual fracture clinic service: A more tactful approach

Reilly¹

2020

IJOTSS

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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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Opportunities arising from the COVID-19: an international orthopaedic surgeons’ perspective

Howard

Robinson²,

Lind³

et al. 2022

Eur J Orthop Surg Traumatol

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Purpose The unprecedented COVID-19 experience has posed severe challenges to the health care system and several of these are documented in orthopaedic surgery; however, although the pandemic has also brought positive changes, these have not been precisely documented. The purpose of this survey is to identify positive perceptions by orthopaedic surgeons at an international level. Methods A cross-sectional, web-based survey inviting 120 orthopaedic surgeons was conducted in April 2020 querying about the positive lessons COVID-19 would teach us. From all responses, thematic codes were obtained and an exploratory thematic analysis was carried out to determine the prevalent themes. Results A total of 100 responses (83% response rate) from a total of seven countries were received. The variety of responses received were grouped into 13 different thematic codes. The thematic analysis generated two major themes: “Virtual reorganization” and “Wellness and sustainability”. Fifty-four per cent of the participants reported positive changes in service reorganization and virtual consultation, whereas 30% replied with an increased feeling of well-being which overlapped with environmental benefits, including reduced paperwork, reduced travelling and increased quality time for family and reflection. Conclusions Despite the negative aspects of the pandemic, responders reported several positive changes particularly relating to service reorganization and personal well-being. This study prompts further larger scale research to unravel further detail in those positive aspects and strongly enhance our future orthopaedic practice.

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Trauma assessment clinic: Virtually a safe and smarter way of managing trauma care in Ireland

Cited by 44 publications

References 50 publications

A national virtual fracture clinic service: A more tactful approach

A national virtual fracture clinic service: A more tactful approach

Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature

Opportunities arising from the COVID-19: an international orthopaedic surgeons’ perspective

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