Bone and soft tissue sarcoma is an uncommon. Benign swellings are, however, common. An approach to tertiary referral is required to accommodate the need for specialist interpretation of all concerning referrals, while maintaining an acceptable time to diagnosis and management.

We aim to describe a new tertiary sarcoma service, utilising modern communication technology and the “virtual clinic” model through a multidisciplinary approach.

All suspected musculoskeletal sarcoma cases are discussed, with available history and imaging, in a virtual clinic by a multidisciplinary team within a week of referral. Clinic decisions allow either immediate discharge, progress to further investigation, or clinic appointment.

Data from the first thousand patients was prospectively collected for initial management decision, and final intervention, and in 625 for waiting time. Almost one third of patients were discharged from the virtual clinic without physical appointment. 45% were sent for further investigation prior to first clinic appointment. Of 625 patients with referral data, mean waiting time was 5.1 days to virtual clinic. For malignant bone and soft tissue tumours, not requiring neoadjuvant treatment, median time to surgery from virtual clinic review was 37 and 47 days respectively.

Through a virtual clinic approach to tertiary sarcoma care, almost a third of referrals have been managed quickly without need for an unnecessary appointment. For 45% of patients the first appointment will be after all necessary investigations have been performed to facilitate rapid decision making. This enables shorter clinic waiting times and rapid transition from first referral to definitive management.

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. Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care. Bone Joint Res 2016;5:33–36. doi: 10.1302/2046-3758.52.2000506

Introduction. A redesign of a joint replacement service to increase throughput and reduce length of stay despite a reduction in junior doctors hours, recognised that Orthopaedic Nurse Practitioners (ONP) based on the US Surgeons’ +. + Assistant model would play a pivotal role in managing patient flow efficiently. Redesigning the Service. The ONP has input at every step of the patient journey. In Outpatient Clinic they see follow-up and selected new patients, commencing the informed consent process if appropriate. They run an information program to patients awaiting surgery, are involved in Pre-Admission clinic, assist in theatre and oversee post-operative care monitoring progress, ensuring earliest possible safe discharge and prescribing as necessary. Continual Audit, Research and development to improve the service are part of the role. Outcomes. The impact of the introduction of the role after 4 years together with service redesign has been:. An increase in the number of new referrals seen in OPD by 50% from 8 to 12 per clinic. An increase in the volume of hip & knee replacements from 490 in 2003 to 834 in 2007. Increased theatre efficiency with routinely 2 joints per session. A reduction in length of stay from mean of 10.75 days in 2003 to 6.89 days in 2007. Continuous monitoring of post-operative infections with current cumulative rate of 0.71%. Improved patient satisfaction as measured by patient feedback sessions. Conclusion. Based on the US Surgeons’ Assistant model, with involvement at every step of the patient journey, ONPs have been the most important single element in the redesign of the joint replacement service to meet a massive increase in demand. Further ONPs are being recruited to fill the gap envisaged by a reduction in junior doctors hours as a result of the European Working Time Directive

Objectives

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).