Bhattacharyya Rahul, Jayaram Prem Ruben, Holliday Robin, Jenkins Paul, Anthony Iain, Rymaszewski Lech
West of Scotland Deanery, UK.
East of England Deanery, UK.
Injury. 2017 Mar;48(3):720-723. doi: 10.1016/j.injury.2017.01.041. Epub 2017 Jan 27.
We re-designed the outpatient management of trauma at our institution to eliminate appointments if there would be no change in management or information provision. All cases referred by the Emergency Department (ED) were reviewed at a Virtual Fracture Clinic (VFC) by an orthopaedic consultant and telephoned afterwards by a senior nurse. If face-to-face review was required, it was arranged at a specialist shoulder clinic.
The primary aim of this study was to evaluate the proportion of clavicle fractures that could be discharged without physical review. The secondary aim was to assess the patient reported functional outcome and satisfaction among patients who were discharged without further review.
A retrospective review was performed of patients who attended the ED with a clavicle fracture between October 2011 and September 2012. 138 patients were included. The number of patients who were discharged without a physical review was analysed. All radiographs were classified according to the Robinson classification. We recorded the number of undisplaced/minimally-displaced fractures that were discharged virtually. The number of patients with a displaced midshaft fracture who were seen at a specialist clinic was also recorded. A questionnaire was sent to all patients at one year post-injury to evaluate their outcome (QuickDASH and EQ-5D) and satisfaction with the new service.
62/138 (45%) were directly discharged from the VFC. The majority of virtual discharges occurred in the undisplaced fracture types (84% versus 13%, RR 6.4, 95% CI 3.5-11.5). 78% patients responded to the questionnaires. 91% of patients were satisfied with their recovery from the injury. 86.4% patients were satisfied with the information provided regarding their treatment. In the virtually discharged group the mean EQ-5D VAS was 78.1 (EQ5D range 0.06-1, SD 0.248). The mean Quick DASH score was 16.1(SD 25.2).
Virtual discharge of undisplaced clavicle fractures is appropriate and results in acceptable clinical outcomes and patient satisfaction. This redesigned process has significant benefits for patients as there were far fewer hospital visits by avoiding unnecessary appointments. The orthopaedic service also benefited by having more time available for the management of complex cases.
我们重新设计了我院创伤门诊的管理流程，若管理方式或信息提供没有变化，则取消预约。急诊科（ED）转诊的所有病例均由骨科顾问在虚拟骨折诊所（VFC）进行评估，随后由高级护士电话随访。若需要面对面评估，则安排在专科肩部诊所进行。
本研究的主要目的是评估无需体格检查即可出院的锁骨骨折患者比例。次要目的是评估未接受进一步检查即出院的患者报告的功能结局和满意度。
对2011年10月至2012年9月期间因锁骨骨折就诊于急诊科的患者进行回顾性研究。纳入138例患者。分析了无需体格检查即出院的患者数量。所有X线片均根据罗宾逊分类法进行分类。我们记录了虚拟出院的无移位/轻度移位骨折的数量。还记录了在专科诊所就诊的中段移位骨折患者的数量。在受伤一年后向所有患者发送问卷，以评估他们的结局（QuickDASH和EQ-5D）以及对新服务的满意度。
62/138（45%）患者直接从VFC出院。大多数虚拟出院发生在无移位骨折类型中（84%对13%，相对危险度6.4，95%置信区间3.5 - 11.5）。78%的患者回复了问卷。91%的患者对受伤后的恢复情况满意。86.4%的患者对所提供的治疗信息满意。在虚拟出院组中，平均EQ-5D视觉模拟评分（VAS）为78.1（EQ5D范围0.06 - 1，标准差0.248）。平均QuickDASH评分为16.1（标准差25.2）。
无移位锁骨骨折的虚拟出院是合适的，可带来可接受的临床结局和患者满意度。这种重新设计的流程对患者有显著益处，因为避免了不必要的预约，患者就诊次数大幅减少。骨科服务也因有更多时间处理复杂病例而受益。
