Background: At the start of the COVID-19 pandemic we introduced a Virtual Fracture Clinic (VFC) in our orthopaedic department in which clinical records and imaging were reviewed by an orthopaedic consultant and physiotherapist / nurse without the patient being physically present. All patients received a copy of the clinic note outlining an agreed management plan. VFC’s have been successfully trailed in other orthopaedic departments, however, no study has reported on the process of setting up a VFC during a pandemic, nor the frequency and types of injuries seen in the clinic.
Objectives: The aims were to document and report the frequency and types of injuries reviewed in VFC and to determine the impact in terms of efficiency (frequency of decreased face to face contacts, cost avoidances), clinical governance and effectiveness (SOS contacts, complaints and adverse effects).
Method: We recorded the type of injury, discharge data, face to face urgent and non-urgent fracture clinic consultations, patients admitted for surgery, SOS queries and any complaints for all patients reviewed in VFC between March -September 2020, we also documented the perceived benefits and less positive features for this new way of working.
Results: In the first 7 months the overall rate of discharge was 2021/3035 patients (66%). Of these 49/3035 (2%) re-contacted under an SOS code with on-going or new problems. There were no formal complaints about the VFC during the study period. 973 patients (31%) were reviewed in the general fracture clinic or subspecialty clinics. Only 41 patients (1.5 %) presenting to the VFC required admission for surgery. The re-design resulted in substantial annual cost avoidance of around £129,000. There were over 100 different types of injuries reviewed.
Conclusion: Our redesigned clinic during the COVID-19 pandemic has proved to be an efficient and safe method to manage fracture patients. It also provides substantial cost savings. Whilst we have not identified any concerns in relation to safety from this way of working, future studies are still needed (and on-going) to add to the growing body of evidence in relation to the VFC model in the longer term.