Effect of a redesigned fracture management pathway and 'virtual' fracture clinic on ED performance.
Vardy J, Jenkins PJ, Clark K, et al. BMJ open 2014 · PMID 24928593 · doi:10.1136/bmjopen-2014-005282
- Question
- Does a consultant-led virtual fracture clinic with direct discharge of simple injuries improve emergency department and fracture clinic performance?
- Design
- Retrospective before-and-after comparison of one year either side of a pathway redesign in a single Scottish ED and orthopaedic unit.
- Patients
- Adults attending the ED with orthopaedic injuries not needing immediate surgery, previously referred to a traditional fracture clinic.
- Intervention
- Virtual fracture clinic review of notes and imaging with direct discharge or targeted appointments for stable injuries
- Comparison
- Traditional face-to-face fracture clinic review of all referrals
- Primary outcome
- ED assessment and treatment time, and unplanned ED reattendance within 7 days
- Key result
- The redesigned pathway, with leaflet-supported direct discharge of minor stable injuries, did not increase unplanned ED reattendance, shortened consultations where backslabs were replaced by removable splints, and reduced unnecessary face-to-face fracture clinic review.
- Limitations
- Non-randomised single-centre before-and-after design using administrative data; patient-reported outcomes were not captured.
- Impact on practice
- The Glasgow model became the template for virtual fracture clinics adopted widely across UK trauma units and endorsed by BOA and GIRFT.