The virtual fracture clinic: Reducing unnecessary review of clavicle fractures.
BACKGROUND
We re-designed the outpatient management of trauma at our institution to eliminate appointments if there would be no change in management or information provision. All cases referred by the Emergency Department (ED) were reviewed at a Virtual Fracture Clinic (VFC) by an orthopaedic consultant and telephoned afterwards by a senior nurse. If face-to-face review was required, it was arranged at a specialist shoulder clinic.


OBJECTIVE
The primary aim of this study was to evaluate the proportion of clavicle fractures that could be discharged without physical review. The secondary aim was to assess the patient reported functional outcome and satisfaction among patients who were discharged without further review.


METHODS
A retrospective review was performed of patients who attended the ED with a clavicle fracture between October 2011 and September 2012. 138 patients were included. The number of patients who were discharged without a physical review was analysed. All radiographs were classified according to the Robinson classification. We recorded the number of undisplaced/minimally-displaced fractures that were discharged virtually. The number of patients with a displaced midshaft fracture who were seen at a specialist clinic was also recorded. A questionnaire was sent to all patients at one year post-injury to evaluate their outcome (QuickDASH and EQ-5D) and satisfaction with the new service.


RESULTS
62/138 (45%) were directly discharged from the VFC. The majority of virtual discharges occurred in the undisplaced fracture types (84% versus 13%, RR 6.4, 95% CI 3.5-11.5). 78% patients responded to the questionnaires. 91% of patients were satisfied with their recovery from the injury. 86.4% patients were satisfied with the information provided regarding their treatment. In the virtually discharged group the mean EQ-5D VAS was 78.1 (EQ5D range 0.06-1, SD 0.248). The mean Quick DASH score was 16.1(SD 25.2).


CONCLUSIONS
Virtual discharge of undisplaced clavicle fractures is appropriate and results in acceptable clinical outcomes and patient satisfaction. This redesigned process has significant benefits for patients as there were far fewer hospital visits by avoiding unnecessary appointments. The orthopaedic service also benefited by having more time available for the management of complex cases.
West of Scotland Deanery, UK. Electronic address: rahulbhattacharyya09@gmail.com.
Rahul
R
Bhattacharyya
East of England Deanery, UK. Electronic address: premruben@yahoo.com.
Prem Ruben
PR
Jayaram
Glasgow Medical School, UK. Electronic address: 1106516H@student.gla.ac.uk.
Robin
R
Holliday
Glasgow Royal Infirmiry, UK. Electronic address: paul@jenkinsnet.org.uk.
Paul
P
Jenkins
Glasgow Royal Infirmiry, UK. Electronic address: iain.anthony@ggc.scot.nhs.uk.
Iain
I
Anthony
Glasgow Royal Infirmiry, UK. Electronic address: lech.rymaszewski@ggc.scot.nhs.uk.
Lech
L
Rymaszewski
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002968:Clavicle / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002985:Clinical Protocols; D005260:Female; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011859:Radiography / Q000191:economics / Q000706:statistics & numerical data*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D063367:Virtual Reality Exposure Therapy; D055815:Young Adult
Clavicle fractures; Outcome; Patient satisfaction; Virtual fracture clinic