Virtual Fracture Care (VFC): Making fracture care easier for patients and clinicians

Dr Clarice Tang1,2, Ms Rebecca  Pile1, Ms Sophie Gore1, Mr Phong  Tran1, Dr  Narelle  Watson1

1Western Health, Footscray, Australia, 2Western Sydney University, Penrith, Australia

Background: In an Australian first, the NHS (UK National Health Service) model for VFC was adapted to include specially trained and credentialed Advanced Practice Physiotherapists making clinical management decisions for simple orthopaedic fractures. VFC aimed to engage patients and General Practitioners (GPs) in safe, timely and effective care for simple fractures; care that is accessible from the patient’s own home and reduces demand for hospital clinic appointments.

Method: A cohort study involving adult patients attending a large Melbourne metropolitan emergency department with an acute orthopaedic fracture. The VFC model comprises two components, triage and virtual (phone) management. Patients were triaged through VFC with those meeting the eligibility criteria offered management via VFC as opposed to a face-to-face clinic appointment. VFC clinicians conducted a phone consultation to provide a detailed management plan and address any patient concerns. Clinicians also provided patients’ GPs with immediate and ongoing management details. This study aimed to evaluate the feasibility, safety and impact on patient’s accessibility of VFC.

Results: The VFC service has triaged 4479 referrals from time of inception (April 2017- January 2019), with 1208 referrals managed by VFC phone consultations (28%). VFC patients received their fracture management plan within three working days. The most common conditions being managed through VFC phone consultations were shoulder dislocations, radial head and base of 5th metatarsal fractures. Patient feedback (n=49) indicated 100% of respondents felt they were treated with respect and dignity by VFC staff, 85% felt involved with decisions about their care and 84% received clear management plans. No adverse events were reported.

Discussion: Outcomes from the study indicate that a physiotherapist-led VFC service provides effective and safe management of simple adult orthopaedic fractures, reduces demand for hospital clinic appointments, improves access and is well accepted by patients.

Acknowledgements: We will like to acknowledge Dr Claire Culley and Ms Melina Shackell for their ongoing support to the project.


Biography:

Dr Clarice Tang is a senior physiotherapist working at the Virtual Fracture Clinic and a senior lecturer at the Western Sydney University. Having worked as an advanced practice physiotherapist in the Emergency Department for five years, she has been involved in the Virtual Fracture Clinic since time of implementation and is enthusiastic to share her experiences with the clinic.

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