Virtual fracture clinic for patients with acute bone injury not requiring immediate on-call review

At King’s College Hospital NHS Foundation Trust, following assessment in A&E, traditionally all patients with an acute bone injury not requiring immediate on-call review were booked into a fracture clinic. There was no method of triaging the most urgent cases prior to their presentation in the fracture clinic.

Situation

All patients with a suspected fracture were booked into fracture clinic following a trip to A&E. Some patients were waiting more than two weeks.

Aspiration

To triage all patients within 72 hours of attendance and provide immediate advice, then, if a clinic review is needed, to be seen at the right time by the right clinician.

Solution and impact

King’s College Hospital NHS Foundation Trust introduced a virtual fracture clinic (VFC) model for patients with an acute bone injury not requiring immediate on-call review. All patients are referred into a virtual review, which takes place within 72 hours of their attendance at A&E.

Following the introduction of the VFC model, all patients are now referred into a virtual review. There are written guidelines for the management of the most common injuries, so the care is standardised between all clinicians on both sites. The most appropriate treatment for their injury is now started immediately.

Impact

The VFC review ensured that patients are brought to fracture clinic at the appropriate timescale for the injury or are referred to other services or a self-management plan when appropriate.

Following VFC review, 48% of patients no longer require a face-to-face fracture clinic review. Most patients are on a self-management plan, or managed in hand therapy or physiotherapy. All patients are advised to contact the VFC team for further advice or review to be arranged if they do not improve as expected, although very few require this. Due to the virtual triaging of patients, the waiting times for appointments in the fracture clinics  have been reduced.

In addition to A&E presentations, GPs can also refer patients to the VFC by using the NHS e-referral service (e-RS).

Functionality

This initiative was undertaken using Allscripts - an electronic health record (EHR) provider that was able to integrate functionality to patient pathways.

The overall functionality was in line with other EHR providers offering a full patient record.

The opportunity to adapt the EHR to link patient pathways supported the adoption of the virtual fracture clinic.

Capabilities

Allscripts is an EHR record provider used in several UK hospitals and has supported work on a range of digital patient pathways.

Ensuring that information for this pathway is maintained in the patient record supports an integrated patient record and visibility of this record for all clinical teams involved in the patient’s care.

Scope

This EHR offers the potential for many more patient pathways to be supported through this technology.

Key figures/quotes

Following VFC review, 48% of patients no longer require a face-to-face fracture clinic review.

Find out more

Read more about delivering a virtual fracture clinic on the Shelford Group website

Key contact

Vicki Rowe, operational lead MSK physiotherapy and VFC at King's College Hospital NHS Foundation Trust

vicki.rowe@nhs.net

Fracture care team at King's College Hospital

kch-tr.fracturecareteam@nhs.net