Traditionally at King’s, following assessment in A&E, all patients with an acute bone injury not requiring immediate on-call review, were booked into a fracture clinic. There was no method of triaging the most urgent cases prior to their presentation in the fracture clinic. Due to the overbooked clinics, for some patients their first appointment in fracture clinic could be two weeks following their injury.
Following the introduction of the Virtual Fracture Clinic model (VFC), all patients are now referred into a virtual review which takes place within 72 hours of their attendance at A&E. There are written guidelines for the management of the most common injuries, so the care is standardised between all clinicians on both sites. The most appropriate treatment for their injury is now started immediately. The VFC has run for six months at the Denmark Hill site and for three months at the Princess Royal University Hospital. It is expected to see approximately 10,600 patients each year across both sites.
Following VFC review, 48% of patients no longer require a face to face fracture clinic review. Most patients are on a self-management plan, or managed in hand therapy or physiotherapy. All patients are advised to contact the VFC team if they do not improve as expected, for further review to be arranged, although very few require this. This shows a great reduction in the number of new patients in the fracture clinic. The VFC team worked with the Electronic Patient Record repatriation team to digitise the process. Electronic reports were also created for the VFC team to monitor and audit the referrals. Each group within the team has a clear set of activities to complete and document within the system leading to standardisation of practice. The VFC team know the status of every patient referral. The data they enter into the system automatically adds to the GP letters meaning there is no re-entry of data and it is easily auditable VFC referral data.