Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
ANZ J Surg. 2021 Jul;91(7-8):1441-1446. doi: 10.1111/ans.16574. Epub 2021 Jan 18.
In Australian health care, the consistent rise in demand for orthopaedic outpatient clinic services is creating marked challenges in the provision of quality care. This study investigates the efficacy and safety of a virtual fracture clinic (VFC) as an alternative model of care for the management of acute injuries and musculoskeletal conditions in the Australian public hospital setting.
A retrospective cohort study of consecutive emergency department (ED) referrals to the Department of Orthopaedic Surgery was conducted comparing outcomes prior to (November 2015-February 2017) and after (March 2017-June 2018) implementation of a VFC. The primary outcome measures assessed were the proportion of referrals virtually discharged and unplanned 30-day ED re-attendance rates.
A total of 737 (36.4%) referrals managed by the VFC were discharged without requiring orthopaedic outpatient clinic attendance. The rate of unplanned ED re-attendances was 5.2% post-VFC implementation compared to 6.5% at baseline (P = 0.01). VFC implementation was also associated with reductions in the average number of orthopaedic outpatient clinic attendances per referral (1.1 versus 1.7, P < 0.01) and the number of referrals lost to follow-up (7.2% versus 14.7%, P < 0.01). In addition, patient wait times for first contact by the orthopaedic team were significantly reduced from a median of 7 (IQR 5, 9) days to 2 (IQR 1, 3) days post-intervention (P < 0.01). No complications or adverse events were reported.
This study demonstrates that a VFC is applicable to the Australian healthcare system, and can lead to effective and safe provision of orthopaedic outpatient care.
在澳大利亚的医疗保健中，对矫形门诊服务的需求持续上升，这给提供高质量的医疗服务带来了巨大的挑战。本研究调查了虚拟骨折诊所（VFC）作为一种替代护理模式，用于管理澳大利亚公立医院中急性损伤和肌肉骨骼疾病的疗效和安全性。
对骨科外科就诊的连续急诊部（ED）转诊患者进行回顾性队列研究，比较 VFC 实施前后（2015 年 11 月至 2017 年 2 月；2017 年 3 月至 2018 年 6 月）的结局。主要评估指标为虚拟出院的转诊比例和计划外 30 天 ED 再就诊率。
共有 737 例（36.4%）通过 VFC 管理的转诊无需矫形门诊就诊。VFC 实施后计划外 ED 再就诊率为 5.2%，而基线时为 6.5%（P=0.01）。VFC 实施还与每例转诊的平均矫形门诊就诊次数（1.1 次与 1.7 次，P<0.01）和失访转诊比例（7.2%与 14.7%，P<0.01）减少相关。此外，患者等待骨科团队首次联系的时间从干预前的中位数 7 天（IQR 5, 9）显著缩短至 2 天（IQR 1, 3）（P<0.01）。没有报告并发症或不良事件。
本研究表明，VFC 适用于澳大利亚的医疗保健系统，可以有效地、安全地提供矫形门诊护理。
