title: Virtual fracture clinic delivers British Orthopaedic Association compliance.
abstract: INTRODUCTION The British Orthopaedic Association recommends that patients referred to fracture clinic are thereafter reviewed within 72 hours. With the aim of improving care by seeking to meet this target, waiting times for fracture clinic appointments in a district general hospital were audited prospectively against this national guideline, with the intervening implementation of a virtual fracture clinic. MATERIALS AND METHODS The study was conducted as a prospective closed-loop audit in which the second cycle took place several months after a change in the clinical pathway for all referrals from the emergency department to fracture clinic. Data were gathered in real-time via a pro forma during fracture clinic consultations. RESULTS The first cycle demonstrated a non-compliant mean waiting time of 10.7 days, with 6% of patients being seen within the 72-hour target. Following the implementation of the virtual fracture clinic, the second cycle found that all patients were reviewed within the 72-hour target (mean 1.3 days). DISCUSSION The improvement in performance was delivered with no increase in clinic capacity. The cost of implementation was negligible. CONCLUSION A simple virtual fracture clinic model delivered a significant reduction in waiting times and achieved compliance with the British Orthopaedic Association guideline. Similar results could be achieved in subsequent deployment elsewhere in the NHS.
authors.affiliation: Croydon Health Services NHS Trust Ringgold Standard Institution, Trauma and Orthopaedics , Croydon , Surrey.
authors.forename: J
authors.initials: J
authors.lastname: Holgate
authors.affiliation: Croydon Health Services NHS Trust Ringgold Standard Institution, Trauma and Orthopaedics , Croydon , Surrey.
authors.forename: S
authors.initials: S
authors.lastname: Kirmani
authors.affiliation: Croydon Health Services NHS Trust Ringgold Standard Institution, Trauma and Orthopaedics , Croydon , Surrey.
authors.forename: B
authors.initials: B
authors.lastname: Anand
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D050723:Fractures, Bone / Q000628:therapy*; D019983:Guideline Adherence; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data; D061665:Time-to-Treatment; D014584:User-Computer Interface; D014850:Waiting Lists
keywords: Bone fractures; Hospital outpatient clinics; Orthopaedic surgery; Quality improvement