To assess the clinical and cost-effectiveness of a virtual fracture clinic (VFC) model, and supplement the literature regarding this service as recommended by The National Institute for Health and Care Excellence (NICE) and the British Orthopaedic Association (BOA). This was a retrospective study including all patients (17 116) referred to fracture clinics in a London District General Hospital from May 2013 to April 2016, using hospital-level data. We used interrupted time series analysis with segmented regression, and direct before-and-after comparison, to study the impact of VFCs introduced in December 2014 on six clinical parameters and on local Clinical Commissioning Group (CCG) spend. Student’s Objectives
Methods
Objectives. “Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway. Methods. National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign. Results. The total staffing costs rose by 4% over the time period (from £1 744 933 to £1 811 301) compared with a national increase of 16%. The total outpatient department rate of attendance fell by 15% compared with a national fall of 5%. Had our local costs increased in line with the national average, an excess expenditure of £212 705 would have been required for staffing costs. Conclusions. The virtual fracture clinic system was associated with less overall use of staff resources in comparison to national cost data. Adoption of this system nationally may have the potential to achieve significant cost savings. Cite this article: P. J. Jenkins.
Current fracture-clinic models, especially in the advent of reductions in junior doctors hours, may limit outpatient trainee education and patient care. We designed a new model of fracture-clinic, involving an initial consultant led case review focused on patient management and trainee education. Prospective outcomes for all new patients attending the redesigned fracture-clinic over a 3-week period in 2010 (n=240) were compared with the traditional clinic in the same period in 2009(n=296). Trainees attending the fracture clinic completed a Likert questionnaire (1 [strongly dissagree] − 5 [strongly agree]) assessing the adequacy of education, support, staff morale & standards of patient care. The percentage of cases given consultant input increased significantly from 33% in 2009 to 84% in 2010 (p< 0.0001), while the proportion of patients requiring physical review by a consultant fell by 21% (p< 0.0001). Return rates were reduced by 14.3% (p< 0.013) & utilization of the nurse lead fracture clinic improved by 10.1% (p< 0.0028). These improvements were most marked in the target group ?StR2 (24.2% & 22.3% respectively). There were significant improvements in staff perception of their education from 2 to 4.75 (p< 0.0001), provision of senior support from 2.38 to 4.5 (p=0.019), morale from 3.68 to 4.13 (p=0.0331) & their overall perception of patient care from 3.25 to 4.5 (p=0.0016). A&E staff found the new style clinic educational, practice changing & that it improved interdisciplinary relations, but did not interfere with their A&E duties. Our model of fracture-clinic redesign has significantly enhanced consultant input into patient care without additional funding. In addition, we have demonstrated increased service efficiency and significant improvements in staff support, morale and education. In the face of current economic and training challenges, we recommend this new model as a tool for enhancing patient and trainee experiences.
Current fracture-clinic models, especially in the advent of reductions in junior doctors hours, may limit outpatient trainee education and patient care. We designed a new model of fracture-clinic, involving an initial consultant led case review focused on patient management and trainee education. Outcomes for all new patients attending the redesigned fracture-clinic over a 3-week period in 2010 were compared with the traditional clinic in the same period in 2009. Health professionals completed a Likert questionnaire assessing their perceptions of education, support, standards of patient care and morale before and after the clinic redesign. 309 and 240 patients attended the clinics in 2009 and 2010 respectively. There was an increase in consultant input into patient management after the redesign (29% versus 84%, p<0.0001), while the proportion of patients requiring physical review by a consultant fell (32% versus 9%). The percentage of new patients discharged by junior medical staff increased (17% versus 25%) with a reciprocal fall in return appointments (55% versus 40%, p<0.0005). Overall, return appointment rates fell significantly (55% versus 40%, p=0.013). Staff perception of education and senior support improved from 2 to 5, morale and overall perception of patient care from 4 to 5. Our model of fracture-clinic redesign has significantly enhanced consultant input into patient care without additional funding. In addition, we have demonstrated increased service efficiency and significant improvements in staff support, morale and education. In the face of current economic and training challenges, we recommend this new model as a tool for enhancing patient and trainee experiences.
