Upscaling Virtual Fracture Clinic Use Is a Safe, Effective Measure in the Delivery of Trauma Care

Abstract

Summary: The Virtual Fracture Clinic (VFC) has proved beneficial in reducing footfall within the hospital setting, improving the cost of running a trauma service, while satisfying the majority of referred patients. The mandatory upscaling of telemedicine use, specifically the enhancement of the VFC, amidst the COVID-19 pandemic, was analyzed. The remit of the VFC within our hospital was expanded so as to include all referred ambulatory trauma. Outcomes of our VFC review over the 6-week period following the introduction of the national Irish COVID-19–related restrictions were gathered. These outcomes were analyzed and compared with the corresponding 6-week period from 2019. A 77.2% increase in the VFC referral volume was observed throughout the COVID-19–related period. Patients were directly discharged in 55.2% of cases in 2020, as opposed to 47.8% in 2019 ( P = 0.044); referred directly for physiotherapy in 32.9% of cases in 2020, as opposed to 28.9% in 2019 ( P = 0.173); and referred to a fracture clinic in 11.9% of cases in 2020, as opposed to 23.7% in 2019 ( P < 0.001). Also, 3.0% of patients returned to the clinic after discharge in 2020, compared with 4.4% in 2019 ( P = 0.237); 4.5% of patients were referred for surgery in 2020, as opposed to 2.2% in 2019 ( P = 0.105). The VFC proved to be an efficient tool in managing ambulatory trauma throughout the pandemic. Upscaling the VFC to include all ambulatory trauma is a safe, effective method in reducing clinic attendances and hospital footfall, whilst ensuring that high care standards are maintained. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Virtual fracture clinic reduces patient X-ray volume for common wrist and ankle fractures

“…Of utmost importance during the COVID-19 pandemic, VFC leads to a reduction in numbers attending physical fracture clinics and facilitates “social distancing,” limiting spread of disease [ 4 , 20 ]. Pre-determined referral criteria ensure appropriate and consistent decisions in the ED, minimising the need for early senior opinion [ 21 ].…”

“…Initially introduced in Scotland by the Glasgow Royal Infirmary Group [ 1 ], virtual fracture clinics (VFCs) have been widely adopted in orthopaedic departments both in Ireland and worldwide as part of the changes in healthcare delivery during the COVID-19 pandemic [ 2 , 3 ]. They have been shown to be a safe and effective method of delivering trauma care for injuries which do not require immediate intervention or specialist management [ 4 ]. Furthermore, the majority of musculoskeletal injuries referred to orthopaedics are managed non-operatively [ 5 ], with a resultant large volume of fracture clinic attendances [ 6 ], making it challenging to accommodate patients in an expedited manner.…”

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

“…Telemedicine was satisfactorily utilised in the care, decision making, and rehabilitation of general orthopaedic disorders, including fracture care, osteoporosis, spine disorders, sports injuries, arthroplasty patients, and post-operative care of patients. 48 , 49 , 50 , 51 , 52 , 53 , 54 The common trends observed by the investigators were a significant reduction in inpatient visits, high patient satisfaction rates, and most importantly, timely care and referral of the patients requiring in-person evaluation. 44 , 52 , 55 Hendrickson et al.…”

“… 48 , 49 , 50 , 51 , 52 , 53 , 54 The common trends observed by the investigators were a significant reduction in inpatient visits, high patient satisfaction rates, and most importantly, timely care and referral of the patients requiring in-person evaluation. 44 , 52 , 55 Hendrickson et al. 56 observed better follow-up compliance among patients receiving post-discharge telemedicine-based care.…”

“…Fifty-nine articles met the inclusion criteria and were considered for the analysis. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 The excluded thirty-four papers were editorials, letters, duplicate entries, and articles with no discussion on telemedicine even in the full text ( Figure 1 ). The monthly contributions trend of the orthopaedic telemedicine-related articles is shown in Figure 2 .…”