VIRTUAL FRACTURE CLINICS A new way of working With Quality improvement Steve Cannon 10th Oct 2016

Chaotic Fracture Clinics Too few templates Long waits for an appt Long waits in the clinics themselves Poor consultant availability Patient frustration Long distances travelled in rural areas

BOA STANDARD Initially devised in 1935!! Patients referred to fracture clinics from ED are seen within 72hrs However- Mean waiting time is 10.7 days Only 6% patients seen within the 72 hr target Holgate et al 2016

Objectives Increased collaboration between ED and orthopaedic services Leaflet supported discharge from ED Virtual review only by orthopaedics Consultant review or other highly qulaified staff

Global Initiatives UK Australia Denmark Finland Hungary

Parameters in Place ED and orthopaedic buy in Dedicated session Increasing usage of braces and thermoplastics as opposed to POP immobilisation Additional PT support Ability to refer to appropriate Ortho. Clinics (Sub-Specialty)

Suitable pathologies Fracture phalanges Fracture 5th metacarpal Fracture 5TH Metatarsal base Fracture radial head and neck Host of soft tissue injuries

Radial Head Fractures Simple fractures discharged with no further review Complex fractures into a virtual clinic. I year study -202 patients 10% required face to face review Overall satisfaction rate 96%in suspected #, 87% in definite # 1% required late surgical management Jayaram PR et al 2014

Paediatric Population 339 fracture clinic referrals Only 63% had a fracture. 10% simple buckle fractures of the distal radius 7% finger fractures 37% merely suspected lateral malleolar fractures Virtual PT led clinic diminishes workload by 30% Ramasubbu B et al 2016

Cost Effective? Introduced in 2009 Monitoring of costs v national average Concludes that there is significant potential for cost savings without loss of patient satisfaction Jenkins et al 2016