The safety and efficacy of a virtual fracture clinic in a major Australian tertiary trauma hospital

Ms Bernarda Cavka1, Ms Emily Cross1, Dr  George Plunkett1, Mr Andrew Oppy1, AProf Andrew Bucknill1, Ms Olga Montvida1, Mr Tom Treseder1

1Royal Melbourne Hospital, Parkville, Australia

Purpose: To evaluate the safety and efficacy of a Virtual Fracture Clinic (VFC) in a major Australian tertiary trauma hospital.

Methods: A VFC was conducted at our institution four days per week by an orthopaedic consultant and senior musculoskeletal physiotherapist. A prospective study with a retrospective control was undertaken comparing the management of Emergency Department (ED) referrals made to orthopaedic outpatient clinics pre VFC implementation (n=1899) and post VFC implementation (n=2023). Key outcomes of interest included outpatient clinic resource utilisation, referrals lost to follow up, unplanned hospital attendances and wait time to orthopaedic contact. Data were extracted from existing hospital databases and a prospective project database. Chi squared test or Fisher’s exact test were used to compare categorical data between pre and post-VFC groups. Wilcoxon Mann-Whitney test was applied for numerical comparisons.

Results:  A total of 737 (36.4%) referrals in the VFC group did not require management via the traditional outpatient orthopaedic clinic. During the post intervention period there were significant reductions in the average number of orthopaedic clinic appointments attended per referral (1.1 versus 1.7 pre VFC, p<0.01), the number of referrals lost to follow up (7.2% versus 14.7% pre VFC, p<0.01) and the ED re-attendance rate (5.2 per 100 presentations versus 6.5 pre VFC, P=0.11). There was also a significant reduction of five days in the median wait time from ED discharge to first orthopaedic contact (2 (1,3) days versus 7 (5,9) days pre-VFC, p<0.01). There were no reported adverse events.

Conclusion: A VFC appears to be an efficacious alternative to traditional orthopaedic outpatient clinics for the management of select ambulatory musculoskeletal conditions. The improvement in resource utilisation did not come at the expense of safety. This model of care appears applicable to the Australian healthcare setting.


Ms Emily Cross (B Phys, GCert Phys, M Phys) APAM, is an Advanced Practice Musculoskeletal Physiotherapist, and Virtual Fracture Clinic Coordinator who works with the Orthopaedic team at The Royal Melbourne Hospital to provide specialist care to patients with acute musculoskeletal injuries.  Emily believes that educating and empowering patients to actively engage in their own healthcare and rehabilitation is the cornerstone of achieving successful outcomes.

Emily has worked for Melbourne Health since 2013.

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2007, Hobart (7th NAHC)

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