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

2. 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

3. 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

4. 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

5. Global Initiatives UK
Australia
Denmark
Finland
Hungary

6. 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)

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

8. 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

9. 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

10. 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