Mr Min Jiat Teng1, Miss Elise Pavey1, Dr Mark Horsley2, Dr Jeffrey Petchell2, Dr Owen Hutchings1, Dianna Jagers1, Julie Penn2, Miranda Shaw1, Freya Raffan1
1RPA Virtual Hospital, Sydney Local Health District, Sydney, Australia, 2Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
The Royal Prince Alfred Hospital (RPA) Fracture Clinic provides orthopaedic outpatient expertise to patients with acute fractures, musculoskeletal injuries, and post-operative follow-ups. There was a 33% increase in patient presentations to this clinic between 2007-2012 without additional resourcing. In FY2019/20, there were 9,384 presentations for fracture management. Increasing Emergency Department presentations and projected local population growth threatens the sustainability of the RPA Fracture Clinic, leading to poor patient and staff experiences. There is evidence from the Royal Melbourne Hospital and the UK National Health Service that Virtual Fracture Clinics (VFC) can provide safe, quality and cost-effective care for patients with simple fractures and musculoskeletal injuries. RPA Virtual Hospital, in collaboration with RPA Orthopaedics, established the VFC in October 2020 to improve quality of care and access. Patients with paediatric forearm, radial head/neck, fibula Weber A, metatarsal and toe fractures are assessed and managed exclusively through virtual modalities, including video, phone call, email or SMS. In its first four months of operation, this clinic received 183 referrals with 79% deemed appropriate for virtual care. 5% of VFC patients were transferred to the RPA Fracture Clinic for further assessment. None of these patients required escalation of care or surgery. Patient reported experience measures showed that all patients stated they received good or excellent care, 86.7% stated reductions in travelling to hospital to receive care, and 73.3% did not miss out on work/school. A formal evaluation of this service is underway to compare the outcomes of virtual care against the in-person clinic.
Min Jiat Teng is the Virtual Fracture Clinic Physiotherapist Coordinator at RPA Virtual Hospital, Sydney Local Health District, NSW. His work focuses on leveraging virtual care to improve access to quality care for patients with musculoskeletal conditions. Through prior positions in successfully rolling out electronic medical records systems, establishing two Leading Better Value Care clinics, and working at the NSW Ministry of Health to standardise the allied health data, he is now establishing and evaluating new virtual models of care to as a solution the current and future healthcare challenges.