title: A new "virtual" patient pathway for the management of radial head and neck fractures.
abstract: BACKGROUND
  Minimally displaced radial head and neck fractures are common and the outcome with conservative treatment is generally excellent. A new protocol was introduced to manage patients with these suspected fractures at a major urban hospital. Simple, undisplaced fractures without other associated injuries or instability were discharged with structured advice but no further face-to-face review. Patients with more complex injuries were reviewed at a "virtual clinic." The aim of this study was to examine the outcome of this process in terms of patient flow, satisfaction, reattendance, and reintervention.
  
  
  METHODS
  The 202 eligible patients, who presented during a 1-year period from October 2011 to October 2012, were identified retrospectively from a prospectively collected administrative database. Mason type III and IV fractures were excluded. A questionnaire was administered by mail or phone call to assess satisfaction with the process, information received, and function.
  
  
  RESULTS
  Twenty (10%) patients required face-to-face review in a clinic, whereas 182 (90%) were managed with direct discharge; 155 patients responded to the survey (77%). The overall satisfaction rate was 96% in the suspected fracture group and 87% in the definite fracture group (P = .08). Satisfaction with the information provided was 95%. Two (1%) required late surgical intervention.
  
  
  CONCLUSIONS
  In this study, patients with suspected Mason I or II fractures were managed with limited face-to-face follow-up with high satisfaction rates. The reintervention rate was extremely low. This process has significant benefits to patients, who have fewer hospital visits, and to orthopaedic departments, which have more time to devote to complex cases.
authors: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK. Electronic address: premruben@yahoo.com.
authors: Prem R
authors: PR
authors: Jayaram
authors: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
authors: Rahul
authors: R
authors: Bhattacharyya
authors: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
authors: Paul J
authors: PJ
authors: Jenkins
authors: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
authors: Iain
authors: I
authors: Anthony
authors: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
authors: Lech A
authors: LA
authors: Rymaszewski
mesh_terms: D000328:Adult; D000368:Aged; D019091:Critical Pathways; D004550:Elbow / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D063367:Virtual Reality Exposure Therapy / Q000379:methods*; D000092464:Elbow Injuries
keywords: Radial head; conservative; cost savings; face-to-face review; fractures; radial neck; satisfaction; virtual clinic